Healthcare Provider Details

I. General information

NPI: 1700476835
Provider Name (Legal Business Name): MAGGIE CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 S GRAND AVE
GLENDORA CA
91740-5433
US

IV. Provider business mailing address

342 HAUSER BLVD APT 406
LOS ANGELES CA
90036-5625
US

V. Phone/Fax

Practice location:
  • Phone: 626-244-7124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: