Provider Demographics
NPI:1295840247
Name:CHEN, CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
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 1:1608 SUNSET OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2848
Mailing Address - Country:US
Mailing Address - Phone:801-582-9493
Mailing Address - Fax:
Practice Address - Street 1:100 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-993-9551
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4919058-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ489642Medicaid
UT107009154102OtherIHC
UT690869OtherDESERET MUTUAL
UTPRA05746OtherMOLINA
MT401765Medicaid
UT93492OtherHEALTHY U
UT2000395OtherUNITED HEALTHCARE
UT64594OtherPEHP
UTQM0000051257OtherALTIUS
AZ489642Medicaid