Healthcare Provider Details

I. General information

NPI: 1902883010
Provider Name (Legal Business Name): KENNETH H CHEN D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SALEM ROAD, SUITE B
WILLINGBORO NJ
08046
US

IV. Provider business mailing address

401 ROUTE 73 N BLDG 10, SUITE 320
MARLTON NJ
08053
US

V. Phone/Fax

Practice location:
  • Phone: 609-871-2060
  • Fax: 609-871-5467
Mailing address:
  • Phone: 609-871-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB059485
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: