Healthcare Provider Details

I. General information

NPI: 1083904254
Provider Name (Legal Business Name): CHING CHEN M D INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17170 COLIMA RD SUITE #E
HACIENDA HEIGHTS CA
91745-6771
US

IV. Provider business mailing address

17170 COLIMA RD SUITE #E
HACIENDA HEIGHTS CA
91745-6771
US

V. Phone/Fax

Practice location:
  • Phone: 626-810-5601
  • Fax: 626-810-2556
Mailing address:
  • Phone: 626-810-5601
  • Fax: 626-810-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberG65094
License Number StateCA

VIII. Authorized Official

Name: MRS. CHING HSIU CHEN
Title or Position: PHD
Credential: M D
Phone: 626-810-5601