Basic Information
Provider Information
NPI: 1508069394
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHEN
FirstName: PHILIP
MiddleName: GA-HOUNG
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7703 FLOYD CURL DR
Address2: MC 7977
City: SAN ANTONIO
State: TX
PostalCode: 782293901
CountryCode: US
TelephoneNumber: 2104509000
FaxNumber:  
Practice Location
Address1: 8300 FLOYD CURL DR
Address2: 6TH FLOOR -6B
City: SAN ANTONIO
State: TX
PostalCode: 782293931
CountryCode: US
TelephoneNumber: 2104509950
FaxNumber: 2104506033
Other Information
ProviderEnumerationDate: 06/08/2007
LastUpdateDate: 07/03/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Y00000XP6597TXY Allopathic & Osteopathic PhysiciansOtolaryngology 

No ID Information.


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