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General NPI Number Information
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NPI Number | 1578977963
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Entity Type | Individual
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Provider Name | JACQUELINE WENJIA CHEN MD
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Gender | Female
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 3509 SPECTRUM BLVD STE A
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City | RICHARDSON
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State | TX
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Zip | 75082-9703
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Country | US
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Telephone | 972-238-1858
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Fax |
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Provider Business Mailing Address
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Address Line | 3509 SPECTRUM BLVD STE A
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City | RICHARDSON
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State | TX
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Zip | 75082-9703
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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 |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 2016034277
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | T9079
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License Number State | TX
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