Provider Demographics
NPI:1285864462
Name:CHEN, YING-JU ANNA (OD)
Entity Type:Individual
Prefix:DR
First Name:YING-JU
Middle Name:ANNA
Last Name:CHEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 PARK BLVD UNIT 1202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5642
Mailing Address - Country:US
Mailing Address - Phone:619-590-1994
Mailing Address - Fax:
Practice Address - Street 1:605 FLETCHER PKWY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-2522
Practice Address - Country:US
Practice Address - Phone:619-590-1994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2150152W00000X
VA0618001879152W00000X
CA33872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist