Provider Demographics
NPI:1376568824
Name:CHEN, JAMES WAY-YOUNG (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WAY-YOUNG
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 1:1575 KENSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1927
Mailing Address - Country:US
Mailing Address - Phone:310-268-3017
Mailing Address - Fax:310-268-4611
Practice Address - Street 1:300 MEDICAL PLAZA
Practice Address - Street 2:#B200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-794-1195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA665002084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A665000OtherMEDICAL PPIN #
CA00A665000OtherMEDICAL PPIN #
CAH94481Medicare UPIN