Provider Demographics
NPI:1770785297
Name:CHEN, GRACE INGAN (MD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:INGAN
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10945 LE CONTE AVE
Mailing Address - Street 2:SUITE 2339
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1687
Mailing Address - Country:US
Mailing Address - Phone:310-825-8253
Mailing Address - Fax:310-794-2199
Practice Address - Street 1:10945 LE CONTE AVE
Practice Address - Street 2:SUITE 2339
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1687
Practice Address - Country:US
Practice Address - Phone:310-825-8253
Practice Address - Fax:310-794-2199
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93707207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A937070Medicaid
CAWA93707CMedicare PIN
CAWA93707BMedicare PIN