Healthcare Provider Details

I. General information

NPI: 1700126505
Provider Name (Legal Business Name): CHEN MEDICAL TAMIAMI AIRPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14261 SW 120TH ST STE 112
MIAMI FL
33186-7273
US

IV. Provider business mailing address

1000 PARK CENTRE BLVD SUITE 136
MIAMI FL
33169-5373
US

V. Phone/Fax

Practice location:
  • Phone: 305-628-6117
  • Fax:
Mailing address:
  • Phone: 305-628-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MARY CHEN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 305-628-6117