Provider Demographics
NPI:1982744942
Name:CHEN, WILLIAM KY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KY
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:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 MEDICAL PLAZA DR STE 140
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2866
Practice Address - Country:US
Practice Address - Phone:916-878-4940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57578207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13841ZOtherMEDICARE ID ROSEVILLE
CAZZZ29516ZOtherMEDICARE ID - LINCOLN
CAZZZ43589ZOtherMEDICARE SUBMITTER ID
CAG57578OtherCA MEDICAL LICENSE
CAZZZ13842ZOtherMEDICARE ID CARMICHAEL
CAG57578OtherCA MEDICAL LICENSE
CAZZZ13842ZOtherMEDICARE ID CARMICHAEL