Provider Demographics
NPI:1295179257
Name:LI, CHEN (MD)
Entity Type:Individual
Prefix:
First Name:CHEN
Middle Name:
Last Name:LI
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 1:3600 GASTON AVE STE 550, WADLEY OFFICE TOWER
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1905
Mailing Address - Country:US
Mailing Address - Phone:214-821-1177
Mailing Address - Fax:
Practice Address - Street 1:3600 GASTON AVE STE 550, WADLEY OFFICE TOWER
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1905
Practice Address - Country:US
Practice Address - Phone:281-795-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10046405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine