Provider Demographics
NPI:1952661829
Name:CHEN, CHRISTINA LYDIA (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:LYDIA
Last Name:CHEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W SAN BERNARDINO RD STE A
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-3797
Mailing Address - Country:US
Mailing Address - Phone:626-966-1909
Mailing Address - Fax:626-209-0331
Practice Address - Street 1:500 W SAN BERNARDINO RD STE A
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3797
Practice Address - Country:US
Practice Address - Phone:626-966-1909
Practice Address - Fax:626-209-0331
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13361207RR0500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology