Provider Demographics
NPI:1447496310
Name:CHEN, JASON CHIH (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHIH
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 1:8705 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5401
Mailing Address - Country:US
Mailing Address - Phone:718-513-6503
Mailing Address - Fax:718-513-6504
Practice Address - Street 1:2431 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4448
Practice Address - Country:US
Practice Address - Phone:917-912-4901
Practice Address - Fax:718-513-6504
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250958208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03251076Medicaid