Provider Demographics
NPI:1164534723
Name:CHEN, JIMMY SHANJUN (MD)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:SHANJUN
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 1:23907 OLD HUNDRED RD
Mailing Address - Street 2:
Mailing Address - City:DICKERSON
Mailing Address - State:MD
Mailing Address - Zip Code:20842-9666
Mailing Address - Country:US
Mailing Address - Phone:408-880-4032
Mailing Address - Fax:
Practice Address - Street 1:18502 OFFICE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886
Practice Address - Country:US
Practice Address - Phone:301-740-2680
Practice Address - Fax:301-560-4924
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD000596602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH82274Medicare UPIN
MDG01447C01Medicare PIN