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NPI Code Detail

MEDICARE: KEVIN CHEN MS, ATC

MEDICARE:   KEVIN  CHEN  MS, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer2000052846CA

General Provider Information

NPI Number : 1164209623
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN CHEN MS, ATC
Provider Business Mailing Address
First Line : 19635 BOMAR CT
Second Line :
City : ROWLAND HEIGHTS
State : CA
Zip : 91748-3267
Country : US
Telephone Number : 626-340-6166
Fax Number :
Provider Business Practice Location Address
First Line : 2000 OTTERBEIN AVE
Second Line :
City : ROWLAND HEIGHTS
State : CA
Zip : 91748-3949
Country : US
Telephone Number : 626-340-6166
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2023
Last Update Date : 09/11/2023

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