Provider Demographics
NPI:1063004067
Name:CHEN, GENEVA GE
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:GE
Last Name:CHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1934
Mailing Address - Country:US
Mailing Address - Phone:323-222-2362
Mailing Address - Fax:323-225-4171
Practice Address - Street 1:3408 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1934
Practice Address - Country:US
Practice Address - Phone:323-222-2362
Practice Address - Fax:323-225-4171
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist