Provider Demographics
NPI:1033220314
Name:CHEN, CHANG WEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANG WEN
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10430 LOVELL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3227
Mailing Address - Country:US
Mailing Address - Phone:865-693-6882
Mailing Address - Fax:865-693-2909
Practice Address - Street 1:10430 LOVELL CENTER DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3227
Practice Address - Country:US
Practice Address - Phone:865-693-6882
Practice Address - Fax:865-693-2909
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD27018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3094584Medicaid
TN3094584Medicare ID - Type Unspecified
TN3094584Medicaid