MEDICARE: MARY CHEN MD INC

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
1	207R00000X	Internal Medicine Physician	A78207	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366591174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY CHEN MD INC

Provider Business Mailing Address
First Line	:	18780 AMAR RD
Second Line	:	SUITE 107
City	:	WALNUT
State	:	CA
Zip	:	91789-4560
Country	:	US
Telephone Number	:	626-810-6777
Fax Number	:

Provider Business Practice Location Address
First Line	:	18780 AMAR RD
Second Line	:	SUITE 107
City	:	WALNUT
State	:	CA
Zip	:	91789-4560
Country	:	US
Telephone Number	:	626-810-6777
Fax Number	:	626-810-6687

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARY CHEN
Credential	:	MD
Telephone Number	:	626-810-6777

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	04/23/2020

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Directions to “MARY CHEN MD INC ” Practice Location

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