Provider Demographics
NPI:1740277060
Name:CHEN, DILLON C (MD)
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:C
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 1:1541 ROCHESTER WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5485
Mailing Address - Country:US
Mailing Address - Phone:512-705-3953
Mailing Address - Fax:
Practice Address - Street 1:4860 Y ST STE 3100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA618022085R0202X
TXL18192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142780902Medicaid
TX142780902Medicaid
TXP00329711Medicare PIN
TX8G4641Medicare PIN