Healthcare Provider Details

I. General information

NPI: 1487272647
Provider Name (Legal Business Name): CARLITOS CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S ARROYO PKWY STE 310
PASADENA CA
91105-3930
US

IV. Provider business mailing address

10 W BAY STATE ST UNIT 684
ALHAMBRA CA
91802-2828
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-4859
  • Fax: 626-403-0311
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58795
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number58795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: