Provider Demographics
NPI:1255339255
Name:JUNE S CHEN MD PC
Entity type:Organization
Organization Name:JUNE S CHEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-943-0401
Mailing Address - Street 1:7240 HIGHLAND DR
Mailing Address - Street 2:SUITE 175
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5532
Mailing Address - Country:US
Mailing Address - Phone:801-943-0401
Mailing Address - Fax:801-943-8897
Practice Address - Street 1:7240 HIGHLAND DRIVE
Practice Address - Street 2:SUITE 175
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-5532
Practice Address - Country:US
Practice Address - Phone:801-943-0401
Practice Address - Fax:801-943-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT47536208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT576866944001Medicaid
UT576866944001Medicaid