Provider Demographics
NPI:1780777292
Name:CHEN, WILLIAM T (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2801 WATERMAN BLVD.
Mailing Address - Street 2:STE 200
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-2987
Mailing Address - Country:US
Mailing Address - Phone:707-428-3687
Mailing Address - Fax:707-422-4327
Practice Address - Street 1:2801 WATERMAN BLVD.
Practice Address - Street 2:STE 200
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-2987
Practice Address - Country:US
Practice Address - Phone:707-428-3687
Practice Address - Fax:707-422-4327
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG42521207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG42521OtherSTATE LICENSE
CAA49001Medicare UPIN
CAG00425210Medicare ID - Type Unspecified