Healthcare Provider Details

I. General information

NPI: 1649352774
Provider Name (Legal Business Name): KATHY DIANA CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ERIE AVENUE AT FRONT STREET ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN, GASTRO
PHILADELPHIA PA
19134
US

IV. Provider business mailing address

329 MULBERRY LN
ELKINS PARK PA
19027-1610
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-6778
  • Fax: 215-427-6782
Mailing address:
  • Phone: 215-886-1379
  • Fax: 215-427-6782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMD-424334
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: