Healthcare Provider Details

I. General information

NPI: 1407181258
Provider Name (Legal Business Name): WAN-KEUNG CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDREN'S PLACE MB18
MADERA CA
93636-8761
US

IV. Provider business mailing address

9300 VALLEY CHILDREN'S PLACE MB18
MADERA CA
93636
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-6022
  • Fax: 559-353-7176
Mailing address:
  • Phone: 559-353-6022
  • Fax: 559-353-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number257167
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number257167
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number162621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: