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NPI Code Detail

MEDICARE: MR. CHANG (KENNY) JIAN CHEN FNP, BC

MEDICARE: MR. CHANG (KENNY) JIAN CHEN FNP, BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF333761NY

General Provider Information

NPI Number : 1275625634
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHANG (KENNY) JIAN CHEN FNP, BC
Provider Business Mailing Address
First Line : 1832 84TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11214-2915
Country : US
Telephone Number : 917-282-7683
Fax Number :
Provider Business Practice Location Address
First Line : 2266 CROPSEY AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11214-5706
Country : US
Telephone Number : 718-266-6100
Fax Number : 718-265-3344
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2006
Last Update Date : 09/27/2022

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