Healthcare Provider Details

I. General information

NPI: 1528492949
Provider Name (Legal Business Name): LI-CHIEN CHEN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 S EASTERN AVE STE 1
LAS VEGAS NV
89119-7851
US

IV. Provider business mailing address

6040 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-5613
US

V. Phone/Fax

Practice location:
  • Phone: 702-410-5319
  • Fax: 702-442-1494
Mailing address:
  • Phone: 702-476-4900
  • Fax: 702-476-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberDO2045
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: