Provider Demographics
NPI:1811644214
Name:CHEN, MAGGIE (RD)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:18784 ALDERBURY DR
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4805
Mailing Address - Country:US
Mailing Address - Phone:626-548-9858
Mailing Address - Fax:
Practice Address - Street 1:3230 E IMPERIAL HWY STE 300
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6751
Practice Address - Country:US
Practice Address - Phone:626-548-9858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86081291133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty