Healthcare Provider Details

I. General information

NPI: 1902009418
Provider Name (Legal Business Name): AGNES CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST BOX 468
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST BOX 468
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-4168
  • Fax:
Mailing address:
  • Phone: 310-222-4168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA80127
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA80127
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA80127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: