Healthcare Provider Details

I. General information

NPI: 1083751358
Provider Name (Legal Business Name): ROBERT CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2646 LAKE VIEW AVE
LOS ANGELES CA
90039-4021
US

IV. Provider business mailing address

2646 LAKE VIEW AVE
LOS ANGELES CA
90039-4021
US

V. Phone/Fax

Practice location:
  • Phone: 303-913-4146
  • Fax:
Mailing address:
  • Phone: 303-913-4146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberA104327
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA104327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: