Healthcare Provider Details

I. General information

NPI: 1407993850
Provider Name (Legal Business Name): WEN-TE TED CHEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WEN-TE CHEN

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 CIBECUE CIRCLE RD
SAN CARLOS AZ
85550-0208
US

IV. Provider business mailing address

223 CIBECUE CIRCLE RD
SAN CARLOS AZ
85550-0208
US

V. Phone/Fax

Practice location:
  • Phone: 928-475-7219
  • Fax:
Mailing address:
  • Phone: 928-475-7219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: