Provider Demographics
NPI:1205821477
Name:CHEN, STEPHEN P (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
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 1:500 N GARFIELD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1242
Mailing Address - Country:US
Mailing Address - Phone:626-280-4393
Mailing Address - Fax:626-280-5379
Practice Address - Street 1:500 N GARFIELD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1242
Practice Address - Country:US
Practice Address - Phone:626-280-4393
Practice Address - Fax:626-280-5379
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71696207R00000X, 207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A716960Medicaid
CAWA71696BMedicare ID - Type Unspecified
CA00A716960Medicaid