Provider Demographics
NPI:1295798213
Name:CHEN, VAN TZE (MD)
Entity type:Individual
Prefix:DR
First Name:VAN
Middle Name:TZE
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 1:1760 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1160
Mailing Address - Country:US
Mailing Address - Phone:909-473-1200
Mailing Address - Fax:909-473-1230
Practice Address - Street 1:1760 W 16TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1160
Practice Address - Country:US
Practice Address - Phone:909-473-1200
Practice Address - Fax:909-473-1230
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79198208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G791980Medicare ID - Type Unspecified
CAF82790Medicare UPIN