MEDICARE: KENNETH 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	208000000X	Pediatrics Physician	NY241700	NY
2	208000000X	Pediatrics Physician	062825	GA

General Provider Information

NPI Number	:	1881794881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH CHEN M.D.

Provider Business Mailing Address
First Line	:	2213 A EXCHANGE PLACE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6723
Country	:	US
Telephone Number	:	770-483-4431
Fax Number	:	770-760-7200

Provider Business Practice Location Address
First Line	:	2213 A EXCHANGE PLACE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6723
Country	:	US
Telephone Number	:	770-483-4431
Fax Number	:	770-760-7200

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	11/16/2009

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