Provider Demographics
NPI:1205276458
Name:CHEN, JARREAU (MD)
Entity type:Individual
Prefix:
First Name:JARREAU
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12500 STOCKDAY HWY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314
Mailing Address - Country:US
Mailing Address - Phone:616-564-3300
Mailing Address - Fax:616-564-3301
Practice Address - Street 1:9300 VALLEY CHILDRENS PL # FE10
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8762
Practice Address - Country:US
Practice Address - Phone:559-353-5941
Practice Address - Fax:559-353-5945
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286033208000000X, 2080P0205X, 208000000X
CA1558892080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205276458Medicaid