Provider Demographics
NPI:1699237420
Name:CHEN, KATHERINE GRACE (MS)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:GRACE
Last Name:CHEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 HEALTH SCIENCES RD FL 3
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92617-3058
Mailing Address - Country:US
Mailing Address - Phone:949-824-7105
Mailing Address - Fax:
Practice Address - Street 1:850 HEALTH SCIENCES RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-7242
Practice Address - Country:US
Practice Address - Phone:949-824-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.076053390200000X
CAA184907207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program