Provider Demographics
NPI:1568445229
Name:CHEN, MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LEI
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:18780 AMAR RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4560
Mailing Address - Country:US
Mailing Address - Phone:626-810-6777
Mailing Address - Fax:626-810-6687
Practice Address - Street 1:18780 AMAR RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-4560
Practice Address - Country:US
Practice Address - Phone:626-810-6777
Practice Address - Fax:626-810-6687
Is Sole Proprietor?:No
Enumeration Date:2005-11-26
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78207207Q00000X, 207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI10737Medicare UPIN
CAWA78207AMedicare PIN
CAWA78207BMedicare PIN
CAP00379119Medicare PIN