Healthcare Provider Details

I. General information

NPI: 1295055358
Provider Name (Legal Business Name): MRS. FANGYUN LU CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9715 OTIS ST
SOUTH GATE CA
90280-4931
US

IV. Provider business mailing address

9715 OTIS ST
SOUTH GATE CA
90280-4931
US

V. Phone/Fax

Practice location:
  • Phone: 323-566-1198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number38580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: