Healthcare Provider Details

I. General information

NPI: 1417933243
Provider Name (Legal Business Name): EUGENE CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 NEWPORT BLVD STE 340
COSTA MESA CA
92627-7730
US

IV. Provider business mailing address

1640 NEWPORT BLVD STE 340
COSTA MESA CA
92627-7730
US

V. Phone/Fax

Practice location:
  • Phone: 949-645-4670
  • Fax: 949-722-6866
Mailing address:
  • Phone: 949-645-4670
  • Fax: 949-722-6866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA75342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: