Healthcare Provider Details

I. General information

NPI: 1073759627
Provider Name (Legal Business Name): TINA S CHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7862 EL CAJON BLVD
LA MESA CA
91942-6712
US

IV. Provider business mailing address

7862 EL CAJON BLVD
LA MESA CA
91942-6712
US

V. Phone/Fax

Practice location:
  • Phone: 619-644-6401
  • Fax: 619-644-6490
Mailing address:
  • Phone: 619-644-6401
  • Fax: 619-644-6490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA106399
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA106399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: