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General NPI Number Information
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NPI Number | 1053766303
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Entity Type | Individual
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Provider Name | LEYUAN JACK CHEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2016
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 1100 MERCER AVE
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City | DECATUR
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State | IN
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Zip | 46733-2303
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Country | US
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Telephone | 260-724-2145
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 MERCER AVE
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City | DECATUR
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State | IN
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Zip | 46733-2303
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Country | US
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Telephone | 260-724-2145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | BP10055775
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01083776A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 31738
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License Number State | NE
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