Basic Information
Provider Information
NPI: 1912165374
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHEN
FirstName: HSIONG
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9110 COLLEGE POINTE CT
Address2:  
City: FORT MYERS
State: FL
PostalCode: 339193244
CountryCode: US
TelephoneNumber: 2392082206
FaxNumber: 2392083994
Practice Location
Address1: 9110 COLLEGE POINTE CT
Address2:  
City: FORT MYERS
State: FL
PostalCode: 339193244
CountryCode: US
TelephoneNumber: 2392082206
FaxNumber: 2392083994
Other Information
ProviderEnumerationDate: 06/01/2008
LastUpdateDate: 11/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400XMD476131PAN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400X36119316ILN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400X21001NHN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400X90492MTN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400XD79395MDY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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