MEDICARE: JEFFREY L 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	208100000X	Physical Medicine & Rehabilitation Physician	A102762	CA

General Provider Information

NPI Number	:	1811183700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY L CHEN M.D.

Provider Business Mailing Address
First Line	:	11835 CARMEL MOUNTAIN RD
Second Line	:	STE 1304-347
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-4609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11835 CARMEL MOUNTAIN RD
Second Line	:	STE 1304-347
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-4609
Country	:	US
Telephone Number	:	858-376-7701
Fax Number	:	760-733-3459

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

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	08/05/2013

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