Healthcare Provider Details

I. General information

NPI: 1144584848
Provider Name (Legal Business Name): CHEN MEDICAL 441, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20801 NW 2ND AVE
MIAMI FL
33169-2103
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI FL
33169-5710
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-1770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MARY CHEN
Title or Position: OWNER
Credential:
Phone: 305-831-4722