Provider Demographics
NPI:1558305623
Name:CHEN, CHUN-NAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUN-NAN
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 1:1700 N ROSE AVE # 135C
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3790
Mailing Address - Country:US
Mailing Address - Phone:805-981-9860
Mailing Address - Fax:805-981-1774
Practice Address - Street 1:1700 N ROSE AVE # 135C
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3790
Practice Address - Country:US
Practice Address - Phone:805-981-9860
Practice Address - Fax:805-981-1774
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2010-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36280208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A362800Medicaid
CA00A362800Medicaid
CAA36280Medicare ID - Type UnspecifiedCA LISC.