Provider Demographics
NPI:1962539585
Name:CHEN, FREDERICK WEN KANG (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:WEN KANG
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 1:243 GREEN VALLEY RD SUITE #E
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019
Mailing Address - Country:US
Mailing Address - Phone:831-728-1410
Mailing Address - Fax:831-728-2076
Practice Address - Street 1:243 GREEN VALLEY RD SUITE #E
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019
Practice Address - Country:US
Practice Address - Phone:831-728-1410
Practice Address - Fax:831-728-2076
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25253207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A252530Medicare ID - Type Unspecified
24347Medicare UPIN