Provider Demographics
NPI:1265927115
Name:CHEN, LAWRENCE (DPM)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 KNOWLES DR STE 117
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1542
Mailing Address - Country:US
Mailing Address - Phone:408-292-8800
Mailing Address - Fax:408-292-8809
Practice Address - Street 1:555 KNOWLES DR STE 117
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1542
Practice Address - Country:US
Practice Address - Phone:408-292-8800
Practice Address - Fax:408-292-8809
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-23
Last Update Date:2022-06-08
Deactivation Date:2018-08-10
Deactivation Code:
Reactivation Date:2019-06-21
Provider Licenses
StateLicense IDTaxonomies
CAE5849213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE5849OtherTHE PODIATRIC MEDICAL BOARD OF CALIFORNIA
XDP046M87616OtherANTHEM BLUE CROSS