Healthcare Provider Details

I. General information

NPI: 1720162167
Provider Name (Legal Business Name): SU SIN CHEN M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 11/22/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 HUNTINGTON DR S
LOS ANGELES CA
90032-1945
US

IV. Provider business mailing address

918 N STONEMAN AVE APT D
ALHAMBRA CA
91801-1428
US

V. Phone/Fax

Practice location:
  • Phone: 323-826-7388
  • Fax: 323-826-7128
Mailing address:
  • Phone: 713-409-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License NumberC56122
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberC56122
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC56122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: