Healthcare Provider Details

I. General information

NPI: 1912369471
Provider Name (Legal Business Name): WINSOR CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BELMONT AVE
YOUNGSTOWN OH
44504-1003
US

IV. Provider business mailing address

1365 CLIFTON ROAD NE BUILDING A, ROOM 2200
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 330-747-1106
  • Fax: 404-251-0604
Mailing address:
  • Phone: 404-727-1994
  • Fax: 404-251-0604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number14084
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35.150142
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: