Provider Demographics
NPI:1568657781
Name:CHEN, FORMOSA CINDY (MD)
Entity type:Individual
Prefix:DR
First Name:FORMOSA
Middle Name:CINDY
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14445 OLIVE VIEW DRIVE
Mailing Address - Street 2:ROOM 6B119-H
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342
Mailing Address - Country:US
Mailing Address - Phone:818-364-3031
Mailing Address - Fax:
Practice Address - Street 1:14445 OLIVE VIEW DRIVE
Practice Address - Street 2:ROOM 6B119-H
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:818-364-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA104170208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery