Healthcare Provider Details

I. General information

NPI: 1144242165
Provider Name (Legal Business Name): FONG H CHEN M.D. & ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 KANSAS AVE
WOODWARD OK
73801-2912
US

IV. Provider business mailing address

1818 KANSAS AVE
WOODWARD OK
73801-2912
US

V. Phone/Fax

Practice location:
  • Phone: 580-254-3396
  • Fax: 580-254-5311
Mailing address:
  • Phone: 580-254-3396
  • Fax: 580-254-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11152
License Number StateOK

VIII. Authorized Official

Name: HELEN S CHIOU
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 580-254-3396