Provider Demographics
NPI:1841210846
Name:CHEN, JOHN W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:WYNE-CHUNG
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2617 E CHAPMAN AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3225
Mailing Address - Country:US
Mailing Address - Phone:714-202-0218
Mailing Address - Fax:714-832-8233
Practice Address - Street 1:2617 E CHAPMAN AVE STE 307
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3225
Practice Address - Country:US
Practice Address - Phone:714-202-0218
Practice Address - Fax:714-832-8233
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG811952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G811950177Medicaid
CAZZZ78036YOtherBLUE PROGRAMS
CAZZZ78036YOtherBLUE PROGRAMS
CAFY167YMedicare Oscar/Certification