1639110737 NPI number — DR. YEN CHOU JOE CHEN M.D.

Table of content: DR. YEN CHOU JOE CHEN M.D. (NPI 1639110737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639110737 NPI number — DR. YEN CHOU JOE CHEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEN
Provider First Name:
YEN CHOU
Provider Middle Name:
JOE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHEN
Provider Other First Name:
YEN CHOU JOE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639110737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
#4 DOCTORS DR
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
OCEAN SPRINGS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-818-0053
Provider Business Mailing Address Fax Number:
228-818-0110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#4 DOCTORS DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
OCEAN SPRINGS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-818-0053
Provider Business Practice Location Address Fax Number:
228-818-0110
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  15921 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00119717 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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