Healthcare Provider Details

I. General information

NPI: 1053329227
Provider Name (Legal Business Name): THOMAS J CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/29/2021
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

IV. Provider business mailing address

393 E WALNUT ST
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-3849
  • Fax: 951-784-3271
Mailing address:
  • Phone: 951-782-3849
  • Fax: 951-784-3271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA85898
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA85898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: