Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | Q8855 | TX |
Y | 2081P2900X | Pain Medicine | Q8855 | TX |
NPI | 1407148604 |
---|---|
Provider Name | Jason Chen |
First Address | Bellaire, TX 77401-2115 |
Second Address | Bellaire, TX 77401-2115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2011 |
Last Update Date | 21/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
366830301 | (05) | TX |
8GB063 | BCBS (01) | TX |