Healthcare Provider Details

I. General information

NPI: 1104403914
Provider Name (Legal Business Name): TRAVIS JUSTIN CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E SPRUCE AVE
FRESNO CA
93720-3374
US

IV. Provider business mailing address

1111 E SPRUCE AVE STE 431
FRESNO CA
93720-3330
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-5777
  • Fax: 556-450-5687
Mailing address:
  • Phone: 559-450-5611
  • Fax: 559-450-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA196727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: