Healthcare Provider Details

I. General information

NPI: 1710341433
Provider Name (Legal Business Name): DAFANG CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S JACKSON ST ACB 3RD FLOOR
LOUISVILLE KY
40202-1622
US

IV. Provider business mailing address

550 S JACKSON ST ACB 3RD FLOOR
LOUISVILLE KY
40202-1622
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5666
  • Fax: 502-852-8980
Mailing address:
  • Phone: 502-852-5666
  • Fax: 502-852-8980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberTP995
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberTP995
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: