Healthcare Provider Details

I. General information

NPI: 1114676780
Provider Name (Legal Business Name): VIVIEN Y CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10313 GEORGIA AVE STE 309
SILVER SPRING MD
20902-5006
US

IV. Provider business mailing address

10313 GEORGIA AVE STE 309
SILVER SPRING MD
20902-5006
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-7000
  • Fax: 301-681-1040
Mailing address:
  • Phone: 301-681-7000
  • Fax: 301-681-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0106508
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: