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General NPI Number Information
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NPI Number | 1780950295
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Entity Type | Organization
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Legal Business Name | PMR KY HOLDING, LLC
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 8019 DIXIE HWY STE 101
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City | LOUISVILLE
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State | KY
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Zip | 40258-1344
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Country | US
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Telephone | 305-653-1770
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Fax | 305-650-0674
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Provider Business Mailing 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 | 33169-2103
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Country | US
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Telephone | 305-653-1770
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Fax | 305-653-0674
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHRISTOPHER J CHEN
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Credential | M.D.
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Telephone | 305-653-1770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101249721
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License Number State | VA
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