Provider Demographics
NPI:1033294285
Name:CHEN, CHI DAI (MD)
Entity Type:Individual
Prefix:
First Name:CHI
Middle Name:DAI
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 1:1040 MARLBORO WAY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-2494
Mailing Address - Country:US
Mailing Address - Phone:843-479-5858
Mailing Address - Fax:843-454-1092
Practice Address - Street 1:1040 MARLBORO WAY
Practice Address - Street 2:SUITE 7
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2494
Practice Address - Country:US
Practice Address - Phone:843-479-5858
Practice Address - Fax:843-454-1092
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22377208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC223779Medicaid
SC000000196767OtherUNISON
SC7162826OtherAETNA
SC407687OtherWELLCARE
SC223779Medicaid
SCP00393373Medicare PIN
SC000000196767OtherUNISON