Provider Demographics
NPI:1952497380
Name:CHEN, JIM NAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:NAN
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JIUN
Other - Middle Name:NAN
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:193 TUMON LN APT 907
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-4318
Mailing Address - Country:US
Mailing Address - Phone:671-488-3750
Mailing Address - Fax:671-649-0640
Practice Address - Street 1:241 FARENHOLT AVE STE 202
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3222
Practice Address - Country:US
Practice Address - Phone:671-649-9693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM001517208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology