Healthcare Provider Details

I. General information

NPI: 1932111986
Provider Name (Legal Business Name): MIKE Y CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W HUNTINGTON DR STE 400
ARCADIA CA
91007-3471
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 626-574-3657
  • Fax:
Mailing address:
  • Phone: 626-775-3514
  • Fax: 626-218-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number0101240161
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA97834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: