Basic Information
| Provider Information | |||||||||
| NPI: | 1649259532 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YI | ||||||||
| FirstName: | CHIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15500 LUNDY PKWY | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481262778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135865011 | ||||||||
| FaxNumber: | 3137927134 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 3RD ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481112605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346979055 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 10/27/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301074619 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | CY074619 | 01 | MI | MEDICAL LICENSE | OTHER |