Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A79823 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | A79823 | CA |
N | 207ND0900X | Dermatopathologist | A79823 | CA |
N | 207NP0225X | Pediatric Dermatologist | A79823 | CA |
N | 207NS0135X | Procedural Dermatology | A79823 | CA |
NPI | 1518919703 |
---|---|
Provider Name | Bryan K Chen |
First Address | San Diego, CA 92131-3974 |
Second Address | San Diego, CA 92131-3974 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 26/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I64998 | (02) | CA |