MEDICARE: DR. JERRICA CHEN MD

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	207P00000X	Emergency Medicine Physician	233844	NY
2	2085U0001X	Diagnostic Ultrasound Physician	233844	NY
3	207P00000X	Emergency Medicine Physician	C54289	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	:	1679558324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRICA CHEN MD

Provider Business Mailing Address
First Line	:	13652 CANTARA ST
Second Line	:	DEPARTMENT OF EMERGENCY MEDICINE
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-5423
Country	:	US
Telephone Number	:	818-375-2013
Fax Number	:

Provider Business Practice Location Address
First Line	:	13652 CANTARA ST
Second Line	:	DEPARTMENT OF EMERGENCY MEDICINE
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-5423
Country	:	US
Telephone Number	:	818-375-2013
Fax Number	:

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	11/29/2021

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Directions to “ DR. JERRICA CHEN MD” Practice Location

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