Healthcare Provider Details

I. General information

NPI: 1912922246
Provider Name (Legal Business Name): CHARLES C. CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N GARFIELD AVE STE 306
MONTEREY PARK CA
91754-1746
US

IV. Provider business mailing address

210 N GARFIELD AVE STE 306
MONTEREY PARK CA
91754-1746
US

V. Phone/Fax

Practice location:
  • Phone: 626-571-6811
  • Fax: 626-571-1213
Mailing address:
  • Phone: 626-571-6811
  • Fax: 626-571-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA39901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: