Healthcare Provider Details

I. General information

NPI: 1861953713
Provider Name (Legal Business Name): JOHN CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/13/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE RD ROOM 4172
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

200 MERCY CIRCLE RD ROOM 4172
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 805-341-1129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101270628
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: