Provider Demographics
NPI:1821138850
Name:CHEN, KUAN-CHENG (MD)
Entity Type:Individual
Prefix:
First Name:KUAN-CHENG
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 1:1000 E LATHAM AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4409
Mailing Address - Country:US
Mailing Address - Phone:951-925-0468
Mailing Address - Fax:951-658-9250
Practice Address - Street 1:1000 E LATHAM AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4409
Practice Address - Country:US
Practice Address - Phone:951-925-0468
Practice Address - Fax:951-658-9250
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30566208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26152Medicare UPIN
CA00A305660Medicare ID - Type Unspecified