MEDICARE: DR. ANDREW HONGKUN CHEN OD

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	152W00000X	Optometrist	35873	CA

General Provider Information

NPI Number	:	1558183897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW HONGKUN CHEN OD

Provider Business Mailing Address
First Line	:	1175 LAKE BLVD APT 202
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-5652
Country	:	US
Telephone Number	:	203-909-2072
Fax Number	:

Provider Business Practice Location Address
First Line	:	1175 LAKE BLVD APT 202
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-5652
Country	:	US
Telephone Number	:	203-909-2072
Fax Number	:

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

Provider Enumeration Date	:	10/28/2024
Last Update Date	:	10/28/2024

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