Healthcare Provider Details

I. General information

NPI: 1093011223
Provider Name (Legal Business Name): CHING CHEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2011
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CAMINO DEL RIO S STE 313
SAN DIEGO CA
92108
US

IV. Provider business mailing address

3663 GARRISON ST
SAN DIEGO CA
92106-2166
US

V. Phone/Fax

Practice location:
  • Phone: 858-333-7932
  • Fax: 828-372-4589
Mailing address:
  • Phone: 858-333-7932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number60 231612
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number60 231612
License Number StateNY

VIII. Authorized Official

Name: DR. CHING CHEN
Title or Position: CHIEF
Credential: DO
Phone: 858-333-7932