Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jack Chen, MD

Individual provider Diagnostic Radiology Physician · NPI 1104356500

Jack Chen, MD is a Diagnostic Radiology in Roseville, Minnesota. Graduated from Saint Louis University School of Medicine in 2017, 9 years ago. Practices with Grand Itasca Clinic and Hospital, a 325-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
9
Trained at
Saint Louis University School of Medicine
Licensed in
MN
In the registry since
2017
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

2355 Hwy 36 W Ste 100
Roseville, MN 55113
Phone: (651) 292-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence 74190 (MN)

Record details

NPI number1104356500
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 18, 2017
Last updated in NPPESJuly 31, 2023
Certification dateJuly 31, 2023
Mailing address2355 Hwy 36 W., Ste. 100, Roseville, MN 55113

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolSAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
Graduated 2017 (9 years in practice)
Group practice Grand Itasca Clinic And Hospital — 325 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations15 on file with Medicare

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