MEDICARE: JIAN A 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	207R00000X	Internal Medicine Physician	G77775	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G77775	OTHER	CA	STATE OF CALIFORNIA
2	00G777750	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1679568612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIAN A CHEN M.D.

Provider Business Mailing Address
First Line	:	3400 DATA DR
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	243 MARCH ST
Second Line	:
City	:	SANTA PAULA
State	:	CA
Zip	:	93060-2511
Country	:	US
Telephone Number	:	805-525-7131
Fax Number	:

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	10/03/2023

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Directions to “ JIAN A CHEN M.D.” Practice Location

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