Provider Demographics
NPI:1235103839
Name:CHEN, LUCI M (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCI
Middle Name:M
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10460 N 92ND ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4549
Mailing Address - Country:US
Mailing Address - Phone:480-922-4600
Mailing Address - Fax:480-922-5231
Practice Address - Street 1:10460 N 92ND ST STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4547
Practice Address - Country:US
Practice Address - Phone:480-922-4600
Practice Address - Fax:480-922-5231
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ277252085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ483587Medicaid
AZ483587Medicaid
AZZ126800Medicare PIN
AZA04718Medicare UPIN
AZZ127576Medicare PIN