Provider Demographics
NPI:1194542696
Name:WEN, CHEN
Entity type:Individual
Prefix:MRS
First Name:CHEN
Middle Name:
Last Name:WEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21836 PINTO WAY
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1491
Mailing Address - Country:US
Mailing Address - Phone:909-323-9247
Mailing Address - Fax:
Practice Address - Street 1:21836 PINTO WAY
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1491
Practice Address - Country:US
Practice Address - Phone:909-323-9247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-154722174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty