MEDICARE: HAN CHEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A108222	CA
2	207T00000X	Neurological Surgery Physician	A108222	CA

General Provider Information

NPI Number	:	1558655811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAN CHEN M.D.

Provider Business Mailing Address
First Line	:	3857 BIRCH ST
Second Line	:	#323
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2616
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3857 BIRCH ST
Second Line	:	#323
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2616
Country	:	US
Telephone Number	:	949-484-4263
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2011
Last Update Date	:	01/05/2017

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