Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 20A18960 | CA |
NPI | 1184116766 |
---|---|
Provider Name | Kimberly Chen |
First Address | San Marino, CA 91108-2730 |
Second Address | Los Angeles, CA 90033-1026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2018 |
Last Update Date | 28/12/2021 |