Provider Demographics
NPI:1720162167
Name:CHEN, SU SIN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SU
Middle Name:SIN
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 N STONEMAN AVE APT D
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1428
Mailing Address - Country:US
Mailing Address - Phone:713-409-7310
Mailing Address - Fax:
Practice Address - Street 1:4880 HUNTINGTON DR S
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1945
Practice Address - Country:US
Practice Address - Phone:323-826-7388
Practice Address - Fax:323-826-7128
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC56122207ZP0007X, 207ZP0102X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194308601Medicaid
TX8U6104OtherBLUE CROSS BLUE SHIELD
TX194308601Medicaid