Basic Information
Provider Information
NPI: 1548423270
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHEN
FirstName: XIANGBAI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD PH D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 844658
Address2:  
City: DALLAS
State: TX
PostalCode: 752844658
CountryCode: US
TelephoneNumber: 2547248800
FaxNumber:  
Practice Location
Address1: 2401 S 31ST ST
Address2:  
City: TEMPLE
State: TX
PostalCode: 765080001
CountryCode: US
TelephoneNumber: 2547242111
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/02/2008
LastUpdateDate: 01/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0102XMT192282PAN Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
207ZP0102XP5607TXY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

No ID Information.


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