Provider Demographics
NPI:1861751273
Name:CHEN, THOMAS TAO-YUAN (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:TAO-YUAN
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 1:2220 BROADRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-1247
Mailing Address - Country:US
Mailing Address - Phone:209-477-1382
Mailing Address - Fax:209-473-6496
Practice Address - Street 1:2220 BROADRIDGE WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-1247
Practice Address - Country:US
Practice Address - Phone:209-477-1382
Practice Address - Fax:209-473-6496
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFE23674174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist