Basic Information
Provider Information
NPI: 1356332639
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHEN
FirstName: YI-BIN
MiddleName: ALBERT
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 9142
Address2:  
City: CHARLESTOWN
State: MA
PostalCode: 021299142
CountryCode: US
TelephoneNumber: 6177241124
FaxNumber: 6176435843
Practice Location
Address1: 55 FRUIT ST
Address2: WAC 625/5
City: BOSTON
State: MA
PostalCode: 021142621
CountryCode: US
TelephoneNumber: 6177262066
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/04/2005
LastUpdateDate: 09/07/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X220342MAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RH0003X220342MAY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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