Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A80482 | CA |
NPI | 1710187802 |
---|---|
Provider Name | Dr. Theodore Chen |
First Address | Los Angeles, CA 90027-5814 |
Second Address | Los Angeles, CA 90027-5814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2007 |
Last Update Date | 06/12/2021 |