Healthcare Provider Details

I. General information

NPI: 1619141629
Provider Name (Legal Business Name): WILLIAM CHEN M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 ENDEAVOR STE 305
IRVINE CA
92618-3177
US

IV. Provider business mailing address

18 ENDEAVOR STE 305
IRVINE CA
92618-3177
US

V. Phone/Fax

Practice location:
  • Phone: 949-585-5188
  • Fax: 949-288-0252
Mailing address:
  • Phone: 949-585-5188
  • Fax: 949-288-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG 34389
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM CHEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-426-0603