Healthcare Provider Details

I. General information

NPI: 1376568824
Provider Name (Legal Business Name): JAMES WAY-YOUNG CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PLAZA #B200
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

1575 KENSINGTON RD
SAN MARINO CA
91108-1927
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-1195
  • Fax:
Mailing address:
  • Phone: 310-268-3017
  • Fax: 310-268-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA66500
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberA66500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: