Healthcare Provider Details

I. General information

NPI: 1194304253
Provider Name (Legal Business Name): KATHLEEN QIYAO CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY CHEN

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-6803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number336533
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number336533
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: