Provider Demographics
NPI:1538248695
Name:CHEN, KARL KONG-YUAN (MD)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:KONG-YUAN
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1502 E RED RIVER ST
Mailing Address - Street 2:#347
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5523
Mailing Address - Country:US
Mailing Address - Phone:361-576-9812
Mailing Address - Fax:361-574-1580
Practice Address - Street 1:2807 N BEN WILSON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5730
Practice Address - Country:US
Practice Address - Phone:361-576-9812
Practice Address - Fax:361-574-1580
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG13532085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760387962OtherEMPLOYER ID - ROAGC
TX742569553OtherEMPLOYER ID - ROAST
TX88R661OtherBLUE CROSS/SHIELD - ROAGC
1295809978OtherGROUP NPI - ROAGC
TX920001500OtherRAIL ROAD MEDICARE
1356415004OtherGROUP NPI - ROAST
TX115779403Medicaid
TX85R631OtherBLUE CROSS/SHIELD - ROAST
TX115779402Medicaid
TX85R631Medicare ID - Type UnspecifiedGROUP#00F16E
TX115779402Medicaid
1356415004OtherGROUP NPI - ROAST