Healthcare Provider Details

I. General information

NPI: 1366021461
Provider Name (Legal Business Name): XIAOFENG CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 W JEFFERSON BLVD STE 110
FORT WAYNE IN
46804-4159
US

IV. Provider business mailing address

7910 W JEFFERSON BLVD STE 110
FORT WAYNE IN
46804-4159
US

V. Phone/Fax

Practice location:
  • Phone: 260-436-4116
  • Fax:
Mailing address:
  • Phone: 260-436-4116
  • 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 StateIN
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number11021962A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: