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General NPI Number Information
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NPI Number | 1497184790
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Entity Type | Organization
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Legal Business Name | CHEN NEIGHBORHOOD MEDICAL COUNTY LINE, LLC
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 20801 NW 2ND AVE
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City | MIAMI
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State | FL
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Zip | 33169
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Country | US
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Telephone | 305-653-1770
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 PARK CENTRE BLVD #136
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City | MIAMI
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State | FL
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Zip | 33169-5373
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER JAMES CHEN
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Credential | M.D.
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Telephone | 305-628-6117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME88821
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License Number State | FL
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