Healthcare Provider Details

I. General information

NPI: 1407241375
Provider Name (Legal Business Name): JASON Y CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 08/31/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25455 BARTON RD STE 102B
LOMA LINDA CA
92354-3139
US

IV. Provider business mailing address

25455 BARTON RD STE 102B
LOMA LINDA CA
92354-3139
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-6444
  • Fax:
Mailing address:
  • Phone: 909-558-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01083898A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA172386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: