Basic Information
| Provider Information | |||||||||
| NPI: | 1376568824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | WAY-YOUNG | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1575 KENSINGTON RD | ||||||||
| Address2: | |||||||||
| City: | SAN MARINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911081927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102683017 | ||||||||
| FaxNumber: | 3102684611 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 MEDICAL PLAZA | ||||||||
| Address2: | #B200 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107941195 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 12/13/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | A66500 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0600X | A66500 | CA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology |
ID Information
| ID | Type | State | Issuer | Description | 00A665000 | 01 | CA | MEDICAL PPIN # | OTHER |