MEDICARE: CHUNG KUANG CHEN M.D.

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
1	2084P0800X	Psychiatry Physician	036051139	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	002201201	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1316958002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHUNG KUANG CHEN M.D.

Provider Business Mailing Address
First Line	:	242 TIMBER TRAIL DR
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1456
Country	:	US
Telephone Number	:	630-747-6353
Fax Number	:

Provider Business Practice Location Address
First Line	:	3624 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-2216
Country	:	US
Telephone Number	:	630-747-6353
Fax Number	:	773-486-1057

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	06/15/2008

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Directions to “ CHUNG KUANG CHEN M.D.” Practice Location

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