Healthcare Provider Details

I. General information

NPI: 1851700694
Provider Name (Legal Business Name): JOHNNY CHEN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2595 E IMPERIAL HWY
BREA CA
92821-6106
US

IV. Provider business mailing address

2595 E IMPERIAL HWY
BREA CA
92821-6106
US

V. Phone/Fax

Practice location:
  • Phone: 714-529-5394
  • Fax: 714-529-5862
Mailing address:
  • Phone: 714-529-5394
  • Fax: 714-529-5862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: