Provider Demographics
NPI:1033163357
Name:CHEN, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
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 1:1000 SOUTH GARFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4709
Mailing Address - Country:US
Mailing Address - Phone:330-296-8239
Mailing Address - Fax:330-296-6528
Practice Address - Street 1:1000 SOUTH GARFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4709
Practice Address - Country:US
Practice Address - Phone:626-281-3383
Practice Address - Fax:626-281-5303
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38336208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0215912Medicaid
A74380Medicare UPIN
OH0215912Medicaid