=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295144103
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NANCY CHEN, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2014
-----------------------------------------------------
Last Update Date | 08/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 511 MANAWAI ST. #401
-----------------------------------------------------
City | KAPOLEI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96707-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-674-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 511 MANAWAI ST. #401
-----------------------------------------------------
City | KAPOLEI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96707-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-674-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. NANCY CHEN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 808-674-2273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MD-10756
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------