=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023131786
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SYLVIA S CHEN P.A.-C, MMS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2007
-----------------------------------------------------
Last Update Date | 12/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 SANTA MONICA BLVD. SUITE 468W
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-255-0990
-----------------------------------------------------
Fax | 310-255-0996
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 SANTA MONICA BLVD. SUITE 468W
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-255-0990
-----------------------------------------------------
Fax | 310-255-0996
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 16216
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------