Healthcare Provider Details

I. General information

NPI: 1457383358
Provider Name (Legal Business Name): HARRY CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 N 6TH ST
FOWLER CA
93625
US

IV. Provider business mailing address

41900 JOHN MUIR DR
COARSEGOLD CA
93614-8895
US

V. Phone/Fax

Practice location:
  • Phone: 559-676-3975
  • Fax: 559-676-3974
Mailing address:
  • Phone: 559-709-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA77537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: