Provider Demographics
NPI:1801966908
Name:KEVIN C CHEN MD INC
Entity type:Organization
Organization Name:KEVIN C CHEN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-235-4567
Mailing Address - Street 1:46 001 KAMEHAMEHA HIGHWAY
Mailing Address - Street 2:CASTLE PROFESSIONAL CENTER SUITE 219
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744
Mailing Address - Country:US
Mailing Address - Phone:808-235-4567
Mailing Address - Fax:
Practice Address - Street 1:46 001 KAMEHAMEHA HIGHWAY
Practice Address - Street 2:CASTLE PROFESSIONAL CENTER SUITE 219
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744
Practice Address - Country:US
Practice Address - Phone:808-235-4567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI02586207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
40055OtherHMSA
0000040055OtherHMSA QUEST
0000BDDMCMedicare ID - Type Unspecified
HIH0000BDDMCMedicare PIN