Provider Demographics
NPI:1396908471
Name:BOB AND DEBORAH CHEN DPM INC
Entity type:Organization
Organization Name:BOB AND DEBORAH CHEN DPM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-242-4046
Mailing Address - Street 1:1908 BENECIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5150
Mailing Address - Country:US
Mailing Address - Phone:626-242-4046
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK EAST SUITE 1500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2021
Practice Address - Country:US
Practice Address - Phone:310-553-2882
Practice Address - Fax:323-879-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4379213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4550280001Medicare NSC