Healthcare Provider Details

I. General information

NPI: 1093169500
Provider Name (Legal Business Name): SIMON CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3881 S WESTERN AVE
LOS ANGELES CA
90062-1105
US

IV. Provider business mailing address

1502 MIDFORK CIR
WALNUT CA
91789-5332
US

V. Phone/Fax

Practice location:
  • Phone: 626-441-6479
  • Fax: 323-293-3327
Mailing address:
  • Phone: 909-967-0093
  • 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 TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA157162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: