Provider Demographics
NPI:1558183897
Name:CHEN, ANDREW HONGKUN (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:HONGKUN
Last Name:CHEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 LAKE BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-5652
Mailing Address - Country:US
Mailing Address - Phone:203-909-2072
Mailing Address - Fax:
Practice Address - Street 1:1175 LAKE BLVD APT 202
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-5652
Practice Address - Country:US
Practice Address - Phone:203-909-2072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35873152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist