Healthcare Provider Details

I. General information

NPI: 1689102527
Provider Name (Legal Business Name): OLIVIA MEI CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 WESTLAKE DR STE 100
WEST LAKE HILLS TX
78746-5373
US

IV. Provider business mailing address

102 WESTLAKE DR STE 100
WEST LAKE HILLS TX
78746-5373
US

V. Phone/Fax

Practice location:
  • Phone: 512-327-7779
  • Fax:
Mailing address:
  • Phone: 512-327-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberT1667
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL0006794
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberT1667
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberT1667
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: