Provider Demographics
NPI:1588608111
Name:CHEN, CHUNG QUAN (MD)
Entity Type:Individual
Prefix:
First Name:CHUNG
Middle Name:QUAN
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 1:890 W STETSON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-7311
Mailing Address - Country:US
Mailing Address - Phone:951-537-6002
Mailing Address - Fax:
Practice Address - Street 1:890 W STETSON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7311
Practice Address - Country:US
Practice Address - Phone:951-537-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA328752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300049524OtherRAILROAD MEDICARE
CA300049623OtherRAILROAD MEDICARE
CA00A328752OtherMEDICARE PTAN
CA00A328753OtherMEDICARE PTAN
CA00A328750Medicaid
CA00A328753OtherMEDICARE PTAN
CA00A328750Medicaid