Healthcare Provider Details

I. General information

NPI: 1720575871
Provider Name (Legal Business Name): WILLIAM CHEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2018
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W BROADWAY STE D&E
FARMINGTON NM
87401-5638
US

IV. Provider business mailing address

1001 W BROADWAY STE D&E
FARMINGTON NM
87401-5638
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-4796
  • Fax: 505-599-9351
Mailing address:
  • Phone: 505-327-4796
  • Fax: 505-599-9351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A17902
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2024-0004
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: