Provider Demographics
NPI:1760423016
Name:CHEN, VICTORIA N (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:N
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3306
Mailing Address - Country:US
Mailing Address - Phone:626-962-5141
Mailing Address - Fax:626-338-4191
Practice Address - Street 1:4126 MAINE AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3306
Practice Address - Country:US
Practice Address - Phone:626-962-5141
Practice Address - Fax:626-338-4191
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80349207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G803490Medicaid
CAGR0071680Medicaid
G28603Medicare UPIN
CAW18846Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CAGR0071680Medicaid