Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D49289 | CA |
Y | 213EG0000X | General Practice | D49289 | CA |
NPI | 1003035239 |
---|---|
Provider Name | Dr. Jing Chen |
First Address | Diamond Bar, CA 91765-2154 |
Second Address | Pomona, CA 91768-3612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D49289 | (05) | CA |