Healthcare Provider Details

I. General information

NPI: 1629728696
Provider Name (Legal Business Name): JUSTIN CHEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 SUNSET BLVD 3RD FLOOR
LOS ANGELES CA
90027
US

IV. Provider business mailing address

4733 W SUNSET BLVD 3RD FLOOR
LOS ANGELES CA
90027
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-1433
  • Fax:
Mailing address:
  • Phone: 323-783-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20A21704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: