Provider Demographics
NPI:1104934348
Name:CHEN, CHIH-LUNG (MD)
Entity type:Individual
Prefix:
First Name:CHIH-LUNG
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SANSOM ST
Mailing Address - Street 2:SUITE 239
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5002
Mailing Address - Country:US
Mailing Address - Phone:215-955-6844
Mailing Address - Fax:215-955-2526
Practice Address - Street 1:1020 SANSOM ST
Practice Address - Street 2:SUITE 239
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5002
Practice Address - Country:US
Practice Address - Phone:215-955-6844
Practice Address - Fax:215-955-2526
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38397207P00000X
PAMD-065522-L207P00000X
NJ25MA08904500207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64069057Medicaid
NJ7721609Medicaid
PA0017125320003Medicaid
PA019644PAGMedicare PIN
PA0017125320003Medicaid