Provider Demographics
NPI:1114054806
Name:CHEN & TSENG SURGICAL MEDICAL CORP
Entity Type:Organization
Organization Name:CHEN & TSENG SURGICAL MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-280-5035
Mailing Address - Street 1:1004 E GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-3031
Mailing Address - Country:US
Mailing Address - Phone:626-280-5035
Mailing Address - Fax:
Practice Address - Street 1:1004 E GARVEY AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-3031
Practice Address - Country:US
Practice Address - Phone:626-280-5035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4358213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5238970001OtherDME SUPPLIER NUMBER
W17239Medicare PIN
E4385Medicare PIN
U08535Medicare UPIN
5238970001OtherDME SUPPLIER NUMBER
CAU87073Medicare UPIN
E4358Medicare PIN