Healthcare Provider Details

I. General information

NPI: 1134895345
Provider Name (Legal Business Name): TAI YU CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 LEGION LOOP UNIT 106
EL MONTE CA
91731-2659
US

IV. Provider business mailing address

PO BOX 4021
EL MONTE CA
91734-0021
US

V. Phone/Fax

Practice location:
  • Phone: 626-716-2992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: