1588620322 NPI number — JUNG-MING CHEN M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588620322 NPI number — JUNG-MING CHEN M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CHEN

Provider First Name:

JUNG-MING

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1588620322

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

502 LINDELL AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

LEOMINSTER

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01453-5452

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

978-534-9198

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

50 MEMORIAL DR

Provider Second Line Business Practice Location Address:

SUITE 203

Provider Business Practice Location Address City Name:

LEOMINSTER

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01453-2238

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

978-534-9488

Provider Business Practice Location Address Fax Number:

978-534-3552

Provider Enumeration Date:

04/21/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 146D00000X , with the licence number:  45238 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 045238 . This is a "TUFTS HEALTH INS." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 130586 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 149440 . This is a "HEALTH SOURCE MASSACHUSSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 18392 . This is a "UNICARE HEALTH INS." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 0107212 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0326 . This is a "CENTRAL MASS HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 07-03063 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 0014374 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 4953 . This is a "FALLON HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: S012044 . This is a "CHAMPUS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 36072 . This is a "HEALTHY START PROGRAM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 98798701 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".