Provider Demographics
NPI:1225286479
Name:CHEN, JOHNNY C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:C
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:937 E MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5909
Mailing Address - Country:US
Mailing Address - Phone:805-922-1739
Mailing Address - Fax:805-922-4197
Practice Address - Street 1:1400 E CHURCH ST
Practice Address - Street 2:MARIAN REGIONAL MEDICAL CENTER DEPT OF ANESTHESIOLOGY
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5906
Practice Address - Country:US
Practice Address - Phone:803-739-3000
Practice Address - Fax:805-739-3716
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2014-02-26
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Provider Licenses
StateLicense IDTaxonomies
CAA106527207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225286479OtherBLUE CROSS OF CA
CA1225286479Medicaid
CA00A1065270OtherBLUE SHIELD FEDERAL
CA0A1065270OtherBLUE SHIELD OF CA
CA1225286479OtherTRICARE
CAFJ915ZMedicare PIN