Healthcare Provider Details

I. General information

NPI: 1780777292
Provider Name (Legal Business Name): WILLIAM T. CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 WATERMAN BLVD. STE 200
FAIRFIELD CA
94534-2987
US

IV. Provider business mailing address

2801 WATERMAN BLVD. STE 200
FAIRFIELD CA
94534-2987
US

V. Phone/Fax

Practice location:
  • Phone: 707-428-3687
  • Fax: 707-422-4327
Mailing address:
  • Phone: 707-428-3687
  • Fax: 707-422-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberG42521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: