Provider Demographics
NPI:1891912432
Name:GARY CHEN MD INC
Entity type:Organization
Organization Name:GARY CHEN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-765-8088
Mailing Address - Street 1:PO BOX 3365
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-3365
Mailing Address - Country:US
Mailing Address - Phone:213-765-8088
Mailing Address - Fax:213-765-8181
Practice Address - Street 1:1513 S. GRAND AVE.
Practice Address - Street 2:SUTE 208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015
Practice Address - Country:US
Practice Address - Phone:213-765-8088
Practice Address - Fax:213-765-8181
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORINA OTHOPEDIC INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-18
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78258207X00000X
207XP3100X
CAA78259207XX0004X, 207XX0005X, 207XX0801X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI43717Medicare UPIN
CAW19273Medicare ID - Type Unspecified