Provider Demographics
NPI:1225387137
Name:CHEN, KELVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KYAW
Other - Middle Name:
Other - Last Name:HTAIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:400 W LE ROY AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7305
Mailing Address - Country:US
Mailing Address - Phone:626-614-7047
Mailing Address - Fax:
Practice Address - Street 1:1104 S GARFIELD AVE STE A
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-7803
Practice Address - Country:US
Practice Address - Phone:626-614-7047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 129170207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine