Provider Demographics
NPI:1710541453
Name:CHEN, CHIHWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHIHWEN
Middle Name:
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 1:16110 VENTURA BLVD APT 416
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2539
Mailing Address - Country:US
Mailing Address - Phone:310-694-4594
Mailing Address - Fax:
Practice Address - Street 1:16110 VENTURA BLVD APT 416
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2539
Practice Address - Country:US
Practice Address - Phone:310-694-4594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019013798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine