Healthcare Provider Details

I. General information

NPI: 1669458246
Provider Name (Legal Business Name): CHUN WEN CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 US HIGHWAY 98 W
MIRAMAR BEACH FL
32550-7228
US

IV. Provider business mailing address

7800 US HIGHWAY 98 W
MIRAMAR BEACH FL
32550-7228
US

V. Phone/Fax

Practice location:
  • Phone: 850-278-3556
  • Fax:
Mailing address:
  • Phone: 850-797-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME104689
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: