MEDICARE: DR. MARY 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	207Q00000X	Family Medicine Physician	A78207	CA
2	207R00000X	Internal Medicine Physician	A78207	CA

General Provider Information

NPI Number	:	1568445229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY CHEN M.D.

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	:	626-810-6687

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2005
Last Update Date	:	04/23/2020

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Directions to “ DR. MARY CHEN M.D.” Practice Location

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