Healthcare Provider Details

I. General information

NPI: 1801194873
Provider Name (Legal Business Name): LEON L CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 TERMINO AVE SUITE 300
LONG BEACH CA
90804-2105
US

IV. Provider business mailing address

1760 TERMINO AVE SUITE 300
LONG BEACH CA
90804-2105
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-8513
  • Fax: 562-933-8744
Mailing address:
  • Phone: 562-933-8513
  • Fax: 562-933-8744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number124950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: