Provider Demographics
NPI:1215311139
Name:CHEN, GRACE E (PHD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:E
Last Name:CHEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:E
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1000 WILSHIRE BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-6279
Mailing Address - Country:US
Mailing Address - Phone:626-268-3405
Mailing Address - Fax:
Practice Address - Street 1:1000 WILSHIRE BLVD STE 240
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-6279
Practice Address - Country:US
Practice Address - Phone:424-201-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34370103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical