Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036154422 | IL |
N | 207R00000X | Internist | MD.33095 | AL |
N | 111NI0900X | Internist | MD.33095 | AL |
N | 207R00000X | Internist | R3048 | TX |
N | 111NI0900X | Internist | R3048 | TX |
N | 207RA0201X | Internist - Allergy & Immunology | R3048 | TX |
N | 207RP1001X | Pulmonary Disease | R3048 | TX |
N | 207RS0012X | Sleep Medicine | R3048 | TX |
NPI | 1679835284 |
---|---|
Provider Name | Dr. Xuesong Chen |
First Address | Urbana, IL 61801 |
Second Address | Champaign, IL 61822-9678 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2012 |
Last Update Date | 12/04/2021 |