Provider Demographics
NPI:1154110633
Name:BIORESTORE WOUND CARE INC.
Entity type:Organization
Organization Name:BIORESTORE WOUND CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-741-5411
Mailing Address - Street 1:2421 SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3653
Mailing Address - Country:US
Mailing Address - Phone:626-741-5411
Mailing Address - Fax:626-741-5412
Practice Address - Street 1:2421 SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3653
Practice Address - Country:US
Practice Address - Phone:626-741-5411
Practice Address - Fax:626-741-5412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty