Provider Demographics
NPI:1730132549
Name:CHEN, MARK Z (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:Z
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:DEPT LA 21555
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-1555
Mailing Address - Country:US
Mailing Address - Phone:949-764-5570
Mailing Address - Fax:949-263-1639
Practice Address - Street 1:ONE HOAG DRIVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-5570
Practice Address - Fax:949-263-0473
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA610102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A610100OtherBS
CA00A610100Medicaid
CA00A610100Medicaid
CAWA61010CMedicare PIN