Healthcare Provider Details

I. General information

NPI: 1306912977
Provider Name (Legal Business Name): YU CHEN JIAO DA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 HOPE ST 145 WATERMAN ST
PROVIDENCE RI
02906-3747
US

IV. Provider business mailing address

885 HOPE ST
PROVIDENCE RI
02906-3747
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-5352
  • Fax: 401-273-2337
Mailing address:
  • Phone: 401-421-5352
  • Fax: 401-273-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberDA 00058
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: