Provider Demographics
NPI:1083610273
Name:CHEN, CHUNG- KWANG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUNG- KWANG
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 1:4580 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1104
Mailing Address - Country:US
Mailing Address - Phone:661-327-4411
Mailing Address - Fax:661-215-1560
Practice Address - Street 1:5000 PHYSICIANS BLVD
Practice Address - Street 2:STE 100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5837
Practice Address - Country:US
Practice Address - Phone:661-215-1500
Practice Address - Fax:661-215-1523
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45385207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A453850Medicaid
CAA12927Medicare UPIN
CA00A453850Medicaid