Provider Demographics
NPI:1669890794
Name:CHEN, JESSE (MD)
Entity type:Individual
Prefix:DR
First Name:JESSE
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 1:237 12TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3919
Mailing Address - Country:US
Mailing Address - Phone:243-619-1272
Mailing Address - Fax:
Practice Address - Street 1:4323 BEN FRANKLIN BLVD STE 700
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2129
Practice Address - Country:US
Practice Address - Phone:919-471-5905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-005572085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology