Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 25627 | AZ |
NPI | 1043201999 |
---|---|
Provider Name | Steven Chen |
First Address | Glendale, AZ 85308-5125 |
Second Address | Glendale, AZ 85308-5090 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 20/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
393645 | (05) | AZ |
F51837 | (02) | AZ |