Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | POD-000996 | AZ |
Y | 222Z00000X | Podiatrist | POD-000996 | AZ |
NPI | 1023514619 |
---|---|
Provider Name | Eric Chen |
First Address | Scottsdale, AZ 85255-7459 |
Second Address | Scottsdale, AZ 85255-7459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2018 |
Last Update Date | 25/07/2021 |