Provider Demographics
NPI:1558813170
Name:CHEN, WESLEY ELLEN
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:ELLEN
Last Name:CHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 NABAL RD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:90631-8249
Mailing Address - Country:US
Mailing Address - Phone:323-442-3550
Mailing Address - Fax:
Practice Address - Street 1:1540 ALCAZAR ST
Practice Address - Street 2:CHP-133
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0080
Practice Address - Country:US
Practice Address - Phone:323-442-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19338225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation