Provider Demographics
NPI:1093961211
Name:CHEN ENTERPRISES INC
Entity Type:Organization
Organization Name:CHEN ENTERPRISES INC
Other - Org Name:PRIMARY CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-452-0420
Mailing Address - Street 1:5551 E KINGS CANYON RD
Mailing Address - Street 2:STE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-4531
Mailing Address - Country:US
Mailing Address - Phone:559-452-0420
Mailing Address - Fax:
Practice Address - Street 1:5551 E KINGS CANYON RD
Practice Address - Street 2:STE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4531
Practice Address - Country:US
Practice Address - Phone:559-452-0420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY491843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116689OtherPK
CA1093961211Medicaid