Provider Demographics
NPI:1689860843
Name:CARL C. CHEN, M.D., INC.
Entity Type:Organization
Organization Name:CARL C. CHEN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-773-0111
Mailing Address - Street 1:301 W BASTANCHURY RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3419
Mailing Address - Country:US
Mailing Address - Phone:714-773-0111
Mailing Address - Fax:714-773-5518
Practice Address - Street 1:301 W BASTANCHURY RD
Practice Address - Street 2:SUITE 140
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3419
Practice Address - Country:US
Practice Address - Phone:714-773-0111
Practice Address - Fax:714-773-5518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30781174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11887Medicare PIN