Provider Demographics
NPI:1083904254
Name:CHING CHEN M D INCORPORATED
Entity Type:Organization
Organization Name:CHING CHEN M D INCORPORATED
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHD
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHING
Authorized Official - Middle Name:HSIU
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:626-810-5601
Mailing Address - Street 1:17170 COLIMA RD
Mailing Address - Street 2:SUITE #E
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6771
Mailing Address - Country:US
Mailing Address - Phone:626-810-5601
Mailing Address - Fax:626-810-2556
Practice Address - Street 1:17170 COLIMA RD
Practice Address - Street 2:SUITE #E
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6771
Practice Address - Country:US
Practice Address - Phone:626-810-5601
Practice Address - Fax:626-810-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65094261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G650940Medicaid
CAG65094Medicare PIN
CA00G650940Medicaid