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General NPI Number Information
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NPI Number | 1265689442
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Entity Type | Individual
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Provider Name | KENNETH CHEN
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Gender | Male
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 711 FAIRMOUNT AVE
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City | PASADENA
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State | CA
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Zip | 91105-3103
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Country | US
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Telephone | 626-394-2285
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Fax |
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Provider Business Mailing Address
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Address Line | 350 E DEL MAR BLVD APT 201
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City | PASADENA
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State | CA
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Zip | 91101-2752
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Country | US
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Telephone | 626-394-2285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | STUDENT
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License Number State | CA
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