Healthcare Provider Details

I. General information

NPI: 1649366055
Provider Name (Legal Business Name): VICTOR Y. CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PARADISE ROAD SUITE E
MODESTO CA
95351
US

IV. Provider business mailing address

830 SCENIC DR
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4000
  • Fax: 209-558-5036
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA72236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: