Healthcare Provider Details

I. General information

NPI: 1104123199
Provider Name (Legal Business Name): CINDY CHEN JEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10861 CHERRY ST STE 105
LOS ALAMITOS CA
90720-5403
US

IV. Provider business mailing address

10861 CHERRY ST STE 105
LOS ALAMITOS CA
90720-5403
US

V. Phone/Fax

Practice location:
  • Phone: 562-259-8881
  • Fax: 562-259-8887
Mailing address:
  • Phone: 562-259-8881
  • Fax: 562-259-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA118356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: