MEDICARE: VICKI CHEN

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	363A00000X	Physician Assistant	52051	CA

General Provider Information

NPI Number	:	1417351016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI CHEN

Provider Business Mailing Address
First Line	:	23371 MULHOLLAND DR # 505
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2734
Country	:	US
Telephone Number	:	248-760-4340
Fax Number	:

Provider Business Practice Location Address
First Line	:	436 N BEDFORD DR STE 306
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4320
Country	:	US
Telephone Number	:	310-271-4401
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	10/16/2024

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Directions to “ VICKI CHEN ” Practice Location

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