Healthcare Provider Details

I. General information

NPI: 1619592649
Provider Name (Legal Business Name): JOSEPH CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HOSPITAL DR STE 110
PALM COAST FL
32164-2453
US

IV. Provider business mailing address

PO BOX 946383
ATLANTA GA
30394-6383
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-1910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number89753
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: