Provider Demographics
NPI:1861505463
Name:CHEN, JIAN-JUN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JIAN-JUN
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 S WASHINGTON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3500
Mailing Address - Country:US
Mailing Address - Phone:321-385-0884
Mailing Address - Fax:321-385-9578
Practice Address - Street 1:407 S WASHINGTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3500
Practice Address - Country:US
Practice Address - Phone:321-385-0884
Practice Address - Fax:321-385-9578
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93471207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME93471OtherMEDICAL LIC
FL28795OtherBLUE CROSS BLUE SHIELD
FL276444000Medicaid
FL28795OtherBLUE CROSS BLUE SHIELD