Healthcare Provider Details

I. General information

NPI: 1497184790
Provider Name (Legal Business Name): CHEN NEIGHBORHOOD MEDICAL COUNTY LINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20801 NW 2ND AVE
MIAMI FL
33169
US

IV. Provider business mailing address

1000 PARK CENTRE BLVD #136
MIAMI FL
33169-5373
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 TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME88821
License Number StateFL

VIII. Authorized Official

Name: DR. CHRISTOPHER JAMES CHEN
Title or Position: OWNER
Credential: M.D.
Phone: 305-628-6117