Healthcare Provider Details

I. General information

NPI: 1447526066
Provider Name (Legal Business Name): JUSTIN ALEXANDER CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S FAIR OAKS AVE STE 405
PASADENA CA
91105-2562
US

IV. Provider business mailing address

4150 V ST # 1110
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 626-352-0010
  • Fax: 626-226-3520
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number127264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: