MEDICARE: LONG 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	164W00000X	Licensed Practical Nurse	VN726568	CA

General Provider Information

NPI Number	:	1770287427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONG CHEN

Provider Business Mailing Address
First Line	:	958 COLINA CREEK TRL
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-1128
Country	:	US
Telephone Number	:	510-418-3330
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 N SANTA FE AVE
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-2001
Country	:	US
Telephone Number	:	760-724-3763
Fax Number	:

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

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	04/17/2023

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Directions to “ LONG CHEN ” Practice Location

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