1417171505 NPI number — WAYNE W CHEN MD PHD

Table of content: WAYNE W CHEN MD PHD (NPI 1417171505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417171505 NPI number — WAYNE W CHEN MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEN
Provider First Name:
WAYNE
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
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:
WEIPIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417171505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 VIA LUCCA
Provider Second Line Business Mailing Address:
F209
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-754-9389
Provider Business Mailing Address Fax Number:
949-754-9330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 CAMPUS DRIVE
Provider Second Line Business Practice Location Address:
US LABS
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-754-9389
Provider Business Practice Location Address Fax Number:
949-754-9330
Provider Enumeration Date:
04/12/2007

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: 207ZH0000X , with the licence number:  A83106 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207ZP0102X , with the licence number: A83106 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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