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General NPI Number Information
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NPI Number | 1619592649
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Entity Type | Individual
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Provider Name | JOSEPH CHEN MD
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Gender | Male
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Dates
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Enumeration Date | 06/16/2020
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 21 HOSPITAL DR STE 110
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City | PALM COAST
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State | FL
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Zip | 32164-2453
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Country | US
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Telephone | 386-586-1910
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 946383
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City | ATLANTA
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State | GA
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Zip | 30394-6383
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 89753
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License Number State | SC
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