Provider Demographics
NPI:1891781753
Name:CHEN, LIDO S (MD)
Entity Type:Individual
Prefix:DR
First Name:LIDO
Middle Name:S
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 1:23521 PASEO DE VALENCIA
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3101
Mailing Address - Country:US
Mailing Address - Phone:949-458-2026
Mailing Address - Fax:949-273-8053
Practice Address - Street 1:23521 PASEO DE VALENCIA
Practice Address - Street 2:SUITE 204
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3101
Practice Address - Country:US
Practice Address - Phone:949-458-2026
Practice Address - Fax:949-273-8053
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40968207LP2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADQ485ZMedicare UPIN
CAA40968AMedicare UPIN