1497752893 NPI number — DR. ALICE CHEN M.D.

Table of content: DR. ALICE CHEN M.D. (NPI 1497752893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497752893 NPI number — DR. ALICE CHEN M.D.

Organization/Personal Information

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

Provider's Other Name Information

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 Information

NPI Number:
1497752893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/17/2006
NPI Reactivation Date:
03/30/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARK RIDGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60068-7406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-568-1870
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4711 GOLF RD
Provider Second Line Business Practice Location Address:
SUITE 808
Provider Business Practice Location Address City Name:
SKOKIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60076-1224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-568-1870
Provider Business Practice Location Address Fax Number:
847-568-1875
Provider Enumeration Date:
06/30/2005

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: 173000000X , with the licence number:  0036-086420 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14D0937849 . This is a "CLIA ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036086420 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1621458 . This is a "BLUE CROSS/BLUE SHEILD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com