Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | G42521 | CA |
NPI | 1780777292 |
---|---|
Provider Name | Dr. William T. Chen |
First Address | Fairfield, CA 94534-2987 |
Second Address | Fairfield, CA 94534-2987 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A49001 | (02) | CA |
G42521 | STATE LICENSE (01) | CA |