Provider Demographics
NPI:1265495691
Name:CHEN, JAMES YNG JEN (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:YNG JEN
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 1:11513 TRAILBROOK LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-6340
Mailing Address - Country:US
Mailing Address - Phone:619-955-7783
Mailing Address - Fax:619-793-4898
Practice Address - Street 1:11513 TRAILBROOK LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-6340
Practice Address - Country:US
Practice Address - Phone:619-955-7783
Practice Address - Fax:619-793-4898
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86644207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A866440Medicaid
CAI41937Medicare UPIN
CAWA86644AMedicare ID - Type Unspecified