1346392990 NPI number — TAK-YIN CHAU O.D.

Table of content: TAK-YIN CHAU O.D. (NPI 1346392990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346392990 NPI number — TAK-YIN CHAU O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAU
Provider First Name:
TAK-YIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAU
Provider Other First Name:
TAK
Provider Other Middle Name:
Y
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1346392990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 JOYCE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYLAND
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01778-4515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-650-3505
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 LITTLETON RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
WESTFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01886-3198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-589-9919
Provider Business Practice Location Address Fax Number:
978-589-9921
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  5676 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 3659 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 153362 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4893790 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0335801 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W16273 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2217847 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 461428 . This is a "TUFT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 99407 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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