Provider Demographics
NPI:1639110737
Name:CHEN, YEN CHOU JOE (MD)
Entity Type:Individual
Prefix:DR
First Name:YEN CHOU
Middle Name:JOE
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YEN CHOU JOE
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:#4 DOCTORS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564
Mailing Address - Country:US
Mailing Address - Phone:228-818-0053
Mailing Address - Fax:228-818-0110
Practice Address - Street 1:#4 DOCTORS DR
Practice Address - Street 2:SUITE C
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564
Practice Address - Country:US
Practice Address - Phone:228-818-0053
Practice Address - Fax:228-818-0110
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15921174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119717Medicaid
MS050000447Medicare ID - Type Unspecified
MS00119717Medicaid