Healthcare Provider Details

I. General information

NPI: 1942786835
Provider Name (Legal Business Name): ANDREW CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2018
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N LA CIENEGA BLVD STE M102
BEVERLY HILLS CA
90211-2288
US

IV. Provider business mailing address

8635 W 3RD ST STE 1070W
LOS ANGELES CA
90048-6137
US

V. Phone/Fax

Practice location:
  • Phone: 310-358-2992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA162217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: