Healthcare Provider Details

I. General information

NPI: 1780135772
Provider Name (Legal Business Name): KATHERINE CHEN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO ST
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

18616 BOLD ST
ROWLAND HEIGHTS CA
91748-2001
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-3342
  • Fax:
Mailing address:
  • Phone: 626-383-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number86000802
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86000802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: