Provider Demographics
NPI:1629113691
Name:CHEN, PO ZAN (MD)
Entity Type:Individual
Prefix:
First Name:PO
Middle Name:ZAN
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 1:2605 W BEVERLY BLVD
Mailing Address - Street 2:2605 1-2 W BEVERLY BLVD
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2309
Mailing Address - Country:US
Mailing Address - Phone:323-722-5700
Mailing Address - Fax:323-722-5701
Practice Address - Street 1:2605 W BEVERLY BLVD
Practice Address - Street 2:2605 1-2 W BEVERLY BLVD
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2309
Practice Address - Country:US
Practice Address - Phone:323-722-5700
Practice Address - Fax:323-722-5701
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A245300Medicaid
CA00A245300Medicaid