Healthcare Provider Details

I. General information

NPI: 1871422428
Provider Name (Legal Business Name): TIM CHIA CHEN OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 SANTA ANA AVE
COSTA MESA CA
92627-1826
US

IV. Provider business mailing address

2130 SANTA ANA AVE
COSTA MESA CA
92627-1826
US

V. Phone/Fax

Practice location:
  • Phone: 949-515-6950
  • Fax:
Mailing address:
  • Phone: 949-515-6950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number8057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: