MEDICARE: DR. LIDO S 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	A40968	CA
2	208VP0000X	Pain Medicine Physician	A40968	CA
3	208VP0014X	Interventional Pain Medicine Physician	A40968	CA

General Provider Information

NPI Number	:	1891781753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIDO S CHEN MD

Provider Business Mailing Address
First Line	:	23521 PASEO DE VALENCIA
Second Line	:	SUITE 204
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3101
Country	:	US
Telephone Number	:	949-458-2026
Fax Number	:	949-273-8053

Provider Business Practice Location Address
First Line	:	23521 PASEO DE VALENCIA
Second Line	:	SUITE 204
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3101
Country	:	US
Telephone Number	:	949-458-2026
Fax Number	:	949-273-8053

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	11/04/2013

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