Individual provider Active NPI

Chungyu Chen

  • Pharmacist
  • Marietta, GA
National Provider Identifier
1336744846
Registry record updated Dec 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RPH-031963 Issued in GA
Practice address
210 Cobb Pkwy S
Marietta, GA 30060-6509
Phone
(770) 429-9092
NPI assigned
Dec 2, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RPH-031963 GA Primary

Addresses

Primary practice location

210 Cobb Pkwy S
Marietta, GA 30060-6509

Mailing address

4647 Woodstone LN
Peachtree Corners, GA 30096-2992
Phone (917) 348-3077

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Connexus

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RPH-031963GAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606867200000",
    "number": "1336744846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4647 WOODSTONE LN",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "300962992",
            "telephone_number": "917-348-3077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 COBB PKWY S",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300606509",
            "telephone_number": "770-429-9092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEN",
        "first_name": "CHUNGYU",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-02",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH-031963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Connexus",
            "affiliation": "N",
            "address_1": "210 Cobb Pkwy S",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300606509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.