Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A78258 | CA |
NPI | 1023016896 |
---|---|
Provider Name | David Chen |
First Address | Santa Ana, CA 92701 |
Second Address | Santa Ana, CA 92701-5330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 27/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H57571 | (02) | CA |