Healthcare Provider Details

I. General information

NPI: 1124654108
Provider Name (Legal Business Name): JUDY CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 W LA PALMA AVE
ANAHEIM CA
92801-2658
US

IV. Provider business mailing address

200 S MANCHESTER AVE # 310
ORANGE CA
92868-3217
US

V. Phone/Fax

Practice location:
  • Phone: 657-282-6356
  • Fax:
Mailing address:
  • Phone: 714-456-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA182802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: