Healthcare Provider Details

I. General information

NPI: 1376875641
Provider Name (Legal Business Name): LEI CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 ENCINO PL NE SUITE 26
ALBUQUERQUE NM
87102-2611
US

IV. Provider business mailing address

717 ENCINO PL NE SUITE 26
ALBUQUERQUE NM
87102-2611
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-4545
  • Fax: 505-884-4114
Mailing address:
  • Phone: 505-884-4545
  • Fax: 505-884-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD2015-0535
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2015-0535
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: