Provider Demographics
NPI:1356670905
Name:XINKE CHEN MD, INC.
Entity Type:Organization
Organization Name:XINKE CHEN MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:XINKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-371-5681
Mailing Address - Street 1:PO BOX 77790
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0126
Mailing Address - Country:US
Mailing Address - Phone:951-907-5386
Mailing Address - Fax:951-371-5681
Practice Address - Street 1:770 MAGNOLIA AVE STE 2G
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3122
Practice Address - Country:US
Practice Address - Phone:951-907-5386
Practice Address - Fax:951-371-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86771207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356670905Medicaid
CADB5372Medicare PIN
CAI24940Medicare UPIN