Healthcare Provider Details

I. General information

NPI: 1952313181
Provider Name (Legal Business Name): DEAN CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 WESTERN TRAILS BLVD STE 101
AUSTIN TX
78745-1574
US

IV. Provider business mailing address

2555 WESTERN TRAILS BLVD STE 101
AUSTIN TX
78745-1574
US

V. Phone/Fax

Practice location:
  • Phone: 737-990-9080
  • Fax: 512-377-1520
Mailing address:
  • Phone: 737-990-9080
  • Fax: 512-377-1520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberK8066
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberK8066
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: