Provider Demographics
NPI:1285870428
Name:CHIN, CHANNING YEE (MD)
Entity type:Individual
Prefix:DR
First Name:CHANNING
Middle Name:YEE
Last Name:CHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 MINEOLA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2042
Mailing Address - Country:US
Mailing Address - Phone:516-616-5500
Mailing Address - Fax:516-625-2939
Practice Address - Street 1:1680 ROUTE 23
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:800-633-8446
Practice Address - Fax:516-625-2939
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109722208600000X
NY296463208600000X
390200000X
NJ25MA104181000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program