Basic Information
Provider Information
NPI: 1033558945
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHEN
FirstName: LIYANG
MiddleName: LEON
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 330 MOUNT AUBURN ST
Address2: DEPT OF MEDICINE
City: CAMBRIDGE
State: MA
PostalCode: 021385502
CountryCode: US
TelephoneNumber: 6174923500
FaxNumber:  
Practice Location
Address1: 330 MOUNT AUBURN ST
Address2: DEPT OF MEDICINE
City: CAMBRIDGE
State: MA
PostalCode: 021385502
CountryCode: US
TelephoneNumber: 6174923500
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/25/2013
LastUpdateDate: 08/04/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X256445MAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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