Basic Information
Provider Information | |||||||||
NPI: | 1851490775 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHING | ||||||||
FirstName: | YIMING | ||||||||
MiddleName: | AVERY | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 280 CHESTNUT ST FL 2 | ||||||||
Address2: |   | ||||||||
City: | SPRINGFIELD | ||||||||
State: | MA | ||||||||
PostalCode: | 011991618 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4137943909 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3500 MAIN ST STE 201 | ||||||||
Address2: |   | ||||||||
City: | SPRINGFIELD | ||||||||
State: | MA | ||||||||
PostalCode: | 011071150 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4137940900 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/21/2006 | ||||||||
LastUpdateDate: | 07/30/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 230078 | MA | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 2086S0129X | 49024 | KY | N |   | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | P8652 | TX | N |   | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 230078 | MA | Y |   | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
ID | Type | State | Issuer | Description | 201358410A (KOHMG) | 05 | IN |   | MEDICAID | 7100402650 (KOHMG) | 05 | KY |   | MEDICAID |