MEDICARE: DR. ELLEN CHING CHEN M.D.

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	208000000X	Pediatrics Physician	206639	MA
2	208000000X	Pediatrics Physician	C55688	CA

General Provider Information

NPI Number	:	1457300097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN CHING CHEN M.D.

Provider Business Mailing Address
First Line	:	27699 JEFFERSON AVE
Second Line	:	SUITE 300
City	:	TEMECULA
State	:	CA
Zip	:	92590-2661
Country	:	US
Telephone Number	:	951-252-8588
Fax Number	:	951-252-8589

Provider Business Practice Location Address
First Line	:	36320 INLAND VALLEY DR
Second Line	:	SUITE 203
City	:	WILDOMAR
State	:	CA
Zip	:	92595-7512
Country	:	US
Telephone Number	:	951-200-2220
Fax Number	:	951-200-2221

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	06/19/2014

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Directions to “ DR. ELLEN CHING CHEN M.D.” Practice Location

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