Provider Demographics
NPI:1023016896
Name:CHEN, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 EAST 1ST. STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701
Mailing Address - Country:US
Mailing Address - Phone:714-547-0104
Mailing Address - Fax:714-973-8612
Practice Address - Street 1:719 E 1ST ST STE C
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5330
Practice Address - Country:US
Practice Address - Phone:714-547-0104
Practice Address - Fax:714-973-8612
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78258208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA78258AMedicare ID - Type Unspecified
CAH57571Medicare UPIN