Provider Demographics
NPI:1669430187
Name:CHEN, ANTHONY JEN (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name: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 1:3640 LOMITA BLVD #303
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-375-1728
Mailing Address - Fax:310-375-1708
Practice Address - Street 1:3640 LOMITA BLVD #303
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-375-1728
Practice Address - Fax:310-375-1708
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19655Medicare ID - Type Unspecified
H58486Medicare UPIN