Healthcare Provider Details

I. General information

NPI: 1013122183
Provider Name (Legal Business Name): CHANG HWA MARY CHEN, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S ANAHEIM BLVD
ANAHEIM CA
92805-5806
US

IV. Provider business mailing address

PO BOX 1809
ORANGE CA
92856-0809
US

V. Phone/Fax

Practice location:
  • Phone: 714-533-6220
  • Fax: 714-563-2891
Mailing address:
  • Phone: 714-560-1580
  • Fax: 714-560-1585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA85504
License Number StateCA

VIII. Authorized Official

Name: CHANG-HWA MARY CHEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-829-8202