Healthcare Provider Details

I. General information

NPI: 1790727790
Provider Name (Legal Business Name): JEANNIE H CHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6039 E GRANT RD
TUCSON AZ
85712-2317
US

IV. Provider business mailing address

6039 E GRANT RD
TUCSON AZ
85712-2317
US

V. Phone/Fax

Practice location:
  • Phone: 520-290-5888
  • Fax: 520-290-5551
Mailing address:
  • Phone: 520-290-5888
  • Fax: 520-290-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number30188
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: