Healthcare Provider Details

I. General information

NPI: 1750826350
Provider Name (Legal Business Name): CHEN CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 W MORTON AVE
PORTERVILLE CA
93257-2331
US

IV. Provider business mailing address

1711 W HENDERSON AVE
PORTERVILLE CA
93257-1588
US

V. Phone/Fax

Practice location:
  • Phone: 559-788-0452
  • Fax:
Mailing address:
  • Phone: 562-229-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number74305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: