Provider Demographics
NPI:1053347161
Name:LI, CHIN-JU (MD)
Entity type:Individual
Prefix:DR
First Name:CHIN-JU
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E 38TH ST
Mailing Address - Street 2:C1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2729
Mailing Address - Country:US
Mailing Address - Phone:212-972-2272
Mailing Address - Fax:212-972-2273
Practice Address - Street 1:311 E 38TH ST
Practice Address - Street 2:C 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2729
Practice Address - Country:US
Practice Address - Phone:212-972-2272
Practice Address - Fax:212-972-2273
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136617207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY67A681Medicare UPIN