Individual
DR. KARL KONG-YUAN CHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2807 N BEN WILSON ST, SUITE 201, VICTORIA, TX 77901-5730
(361) 576-9812
(361) 574-1580
Mailing address
1502 E RED RIVER ST, #347, VICTORIA, TX 77901-5523
(361) 576-9812
(361) 574-1580
Taxonomy
Speciality
Code
Description
License number
State
2085R0203X
Therapeutic Radiology Physician
Primary
G1353
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115779402
—
TX
05
—
115779403
—
TX
01
—
1295809978
GROUP NPI - ROAGC
—
01
—
1356415004
GROUP NPI - ROAST
—
01
—
742569553
EMPLOYER ID - ROAST
TX
01
—
760387962
EMPLOYER ID - ROAGC
TX
01
—
85R631
BLUE CROSS/SHIELD - ROAST
TX
01
—
88R661
BLUE CROSS/SHIELD - ROAGC
TX
01
—
920001500
RAIL ROAD MEDICARE
TX
Enumeration date
11/02/2006
Last updated
02/11/2010
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