Provider Demographics
NPI:1598837569
Name:CHEN, CLAYTON (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:
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 1:3231 BLACK OAK DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-2334
Mailing Address - Country:US
Mailing Address - Phone:612-554-8852
Mailing Address - Fax:
Practice Address - Street 1:PHILLIPS-WANGENSTEEN BLDG FLOOR 1
Practice Address - Street 2:516 DELAWARE STREET SE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI167672085R0203X
MN474862085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology