Provider Demographics
NPI:1366591174
Name:MARY CHEN MD INC
Entity type:Organization
Organization Name:MARY CHEN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-810-6777
Mailing Address - Street 1:18780 AMAR RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4560
Mailing Address - Country:US
Mailing Address - Phone:626-810-6777
Mailing Address - Fax:
Practice Address - Street 1:18780 AMAR RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-4560
Practice Address - Country:US
Practice Address - Phone:626-810-6777
Practice Address - Fax:626-810-6687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78207207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A782070Medicaid
CA00A782070Medicaid