Provider Demographics
NPI:1235125790
Name:CHEN, KUANCHENG (MD)
Entity Type:Individual
Prefix:
First Name:KUANCHENG
Middle Name:
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 1:622 W DUARTE RD
Mailing Address - Street 2:#205
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7606
Mailing Address - Country:US
Mailing Address - Phone:626-821-9075
Mailing Address - Fax:626-821-9076
Practice Address - Street 1:622 W DUARTE RD STE 306
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9282
Practice Address - Country:US
Practice Address - Phone:626-821-9075
Practice Address - Fax:626-821-9076
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G750560Medicaid
G05891Medicare UPIN
CAG75056Medicare ID - Type Unspecified