Provider Demographics
NPI:1972583821
Name:CHEN, CHIAYU (MD)
Entity type:Individual
Prefix:DR
First Name:CHIAYU
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 LA SIERRA AVE STE 104-170
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5271
Mailing Address - Country:US
Mailing Address - Phone:213-537-6481
Mailing Address - Fax:888-878-7782
Practice Address - Street 1:3380 LA SIERRA AVE STE 104-170
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5271
Practice Address - Country:US
Practice Address - Phone:213-537-6481
Practice Address - Fax:888-878-7782
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2023-08-17
Deactivation Date:2023-07-03
Deactivation Code:
Reactivation Date:2023-08-02
Provider Licenses
StateLicense IDTaxonomies
CAG53007207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G530070Medicaid
CA060011922OtherRAILROAD MEDICARE
C88398Medicare UPIN
CA00G530071Medicare PIN