Provider Demographics
NPI:1770928855
Name:CHEN CHEN, JENNY MARITZA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:MARITZA
Last Name:CHEN CHEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:MARITZA
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:7117 ROSEMEAD BLVD
Mailing Address - Street 2:APT 127
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-1352
Mailing Address - Country:US
Mailing Address - Phone:407-963-9464
Mailing Address - Fax:
Practice Address - Street 1:832 S GREVILLEA AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3312
Practice Address - Country:US
Practice Address - Phone:310-419-4354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant