Provider Demographics
NPI:1083617138
Name:CHEN, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
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 1:3121 S MARYLAND PKWY
Mailing Address - Street 2:STE 512
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2310
Mailing Address - Country:US
Mailing Address - Phone:702-796-7150
Mailing Address - Fax:702-796-9071
Practice Address - Street 1:3121 S MARYLAND PKWY
Practice Address - Street 2:STE 512
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2310
Practice Address - Country:US
Practice Address - Phone:702-796-7150
Practice Address - Fax:702-796-9071
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9874207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018275Medicaid
NV34923Medicare PIN
NVG36358Medicare UPIN