Healthcare Provider Details

I. General information

NPI: 1336523737
Provider Name (Legal Business Name): JEFFREY CHEN, DO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N GARFIELD AVE STE 204
MONTEREY PARK CA
91754
US

IV. Provider business mailing address

500 N. GARFIELD AVE SUITE 204
MONTEREY PARK CA
91754
US

V. Phone/Fax

Practice location:
  • Phone: 626-280-4939
  • Fax: 626-280-5379
Mailing address:
  • Phone: 626-280-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A10906
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number20A10906
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number20A10906
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY C CHEN
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 626-280-4393