Provider Demographics
NPI:1487711123
Name:CHEN, MICHAEL MING-CHI (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MING-CHI
Last Name:CHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11333 S 1000 E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5428
Mailing Address - Country:US
Mailing Address - Phone:801-462-2205
Mailing Address - Fax:
Practice Address - Street 1:11333 S 1000 E
Practice Address - Street 2:SUITE 102
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-5428
Practice Address - Country:US
Practice Address - Phone:801-462-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8931208100000X
NVDO13902081P2900X
UT6646778-12042081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1487711123Medicaid
NV1487711123Medicaid