Provider Demographics
NPI:1306912977
Name:JIAO, YU CHEN (DA)
Entity type:Individual
Prefix:
First Name:YU CHEN
Middle Name:
Last Name:JIAO
Suffix:
Gender:M
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3747
Mailing Address - Country:US
Mailing Address - Phone:401-421-5352
Mailing Address - Fax:401-273-2337
Practice Address - Street 1:885 HOPE ST
Practice Address - Street 2:145 WATERMAN ST
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3747
Practice Address - Country:US
Practice Address - Phone:401-421-5352
Practice Address - Fax:401-273-2337
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA 00058171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI31170-6OtherBLUE CROSS PROVIDER NO.
RI49-00010OtherUNITED HEALTH CARE