Basic Information
| Provider Information | |||||||||
| NPI: | 1063962926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEN | ||||||||
| FirstName: | JEFFREY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2508 S 3RD AVE | ||||||||
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| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910065307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262164849 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1011 BALDWIN PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | BALDWIN PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917065806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268511011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2016 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.