Provider Demographics
NPI:1184621666
Name:ABRAHAM CHEN, D.O., INC
Entity type:Organization
Organization Name:ABRAHAM CHEN, D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-466-6310
Mailing Address - Street 1:10995 EUCALYPTUS STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7687
Mailing Address - Country:US
Mailing Address - Phone:909-466-6310
Mailing Address - Fax:909-466-6325
Practice Address - Street 1:10995 EUCALYPTUS STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7687
Practice Address - Country:US
Practice Address - Phone:909-466-6310
Practice Address - Fax:909-466-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A7871OtherCALIFORNIA LICENSE NUMBER
CA00AX78710Medicaid
CABC6626533OtherDEA NUMBER
CABC6626533OtherDEA NUMBER
CAZZZ28740ZMedicare ID - Type Unspecified