Healthcare Provider Details

I. General information

NPI: 1558655811
Provider Name (Legal Business Name): HAN CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2011
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3857 BIRCH ST #323
NEWPORT BEACH CA
92660-2616
US

IV. Provider business mailing address

3857 BIRCH ST #323
NEWPORT BEACH CA
92660-2616
US

V. Phone/Fax

Practice location:
  • Phone: 949-484-4263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA108222
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA108222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: