Healthcare Provider Details

I. General information

NPI: 1972583821
Provider Name (Legal Business Name): CHIAYU CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/17/2023
Certification Date: 08/07/2023
Deactivation Date: 07/03/2023
Reactivation Date: 08/02/2023

III. Provider practice location address

3380 LA SIERRA AVE STE 104-170
RIVERSIDE CA
92503-5271
US

IV. Provider business mailing address

3380 LA SIERRA AVE STE 104-170
RIVERSIDE CA
92503-5271
US

V. Phone/Fax

Practice location:
  • Phone: 213-537-6481
  • Fax: 888-878-7782
Mailing address:
  • Phone: 213-537-6481
  • Fax: 888-878-7782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberG53007
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG53007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: