Healthcare Provider Details

I. General information

NPI: 1104970656
Provider Name (Legal Business Name): PATRICK CHEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 SUPERIOR AVE
COSTA MESA CA
92627-3653
US

IV. Provider business mailing address

1550 SUPERIOR AVE
COSTA MESA CA
92627-3653
US

V. Phone/Fax

Practice location:
  • Phone: 949-650-0640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberA88391
License Number StateCA

VIII. Authorized Official

Name: DR. PATRICK CHU-SHIAN CHEN
Title or Position: ASSOCIATE MEDICAL DIRECTOR
Credential: M.D.
Phone: 415-595-9067