Provider Demographics
NPI:1104050558
Name:CHEN, LEECHUAN ANDY (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:LEECHUAN ANDY
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:1350 FIRST COLONY BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4308
Practice Address - Country:US
Practice Address - Phone:281-277-5200
Practice Address - Fax:281-276-3492
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10034764207R00000X
UT7771248-12052085R0001X
TXQ08892085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338993401Medicaid
TX338993403Medicaid
TXP01555190OtherRAILROAD MEDICARE
TX338993402Medicaid