=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235281205
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IWANT2020 COM INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 E 25TH ST GROUND FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10010-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-741-8628
-----------------------------------------------------
Fax | 212-741-2390
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 PARK AVE S 1ST. FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10010-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-741-8628
-----------------------------------------------------
Fax | 212-741-2390
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | DR. EMIL W CHYNN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-741-8626
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 206774
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------