Provider Demographics
NPI:1992875538
Name:CHEN, THOMAS TUNG CHING (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:TUNG CHING
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:PO BOX 370908
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0908
Mailing Address - Country:US
Mailing Address - Phone:702-454-0014
Mailing Address - Fax:702-454-0018
Practice Address - Street 1:653N TOWN CENTER DR 404
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0518
Practice Address - Country:US
Practice Address - Phone:702-454-0014
Practice Address - Fax:702-454-0018
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8155207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018182OtherMEDICAID
NV003102382OtherMEDICAID HEALTHY KIDS
NV002018182OtherMEDICAID
NVV101696Medicare ID - Type UnspecifiedGROUP ID
NVG87863Medicare UPIN