Provider Demographics
NPI:1366614448
Name:CHEN, JI (PA-C)
Entity type:Individual
Prefix:
First Name:JI
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 VINING ST
Mailing Address - Street 2:SUITE 316
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6114
Mailing Address - Country:US
Mailing Address - Phone:617-732-8500
Mailing Address - Fax:617-975-0919
Practice Address - Street 1:10 VINING ST
Practice Address - Street 2:SUITE 316
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6114
Practice Address - Country:US
Practice Address - Phone:617-732-8500
Practice Address - Fax:617-975-0919
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP2451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant