Provider Demographics
NPI:1104854918
Name:CHEN, HWA LONG (MD)
Entity Type:Individual
Prefix:
First Name:HWA
Middle Name:LONG
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 1:1141 N CHENEY ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-2741
Mailing Address - Country:US
Mailing Address - Phone:217-287-7477
Mailing Address - Fax:217-287-7511
Practice Address - Street 1:1141 N CHENEY ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-2741
Practice Address - Country:US
Practice Address - Phone:217-287-7477
Practice Address - Fax:217-287-7511
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036049201208D00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036049201Medicaid
IL371402519002OtherRURAL HEALTH MEDICARD
IL371402519001OtherRURAL HEALTH MEDICARD
148921Medicare ID - Type Unspecified
624550Medicare ID - Type Unspecified
IL371402519002OtherRURAL HEALTH MEDICARD
D89416Medicare UPIN