Provider Demographics
NPI:1356787576
Name:CHEN, KEVIN (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 S FETTERLY AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1605
Mailing Address - Country:US
Mailing Address - Phone:323-362-1400
Mailing Address - Fax:323-362-1373
Practice Address - Street 1:245 S FETTERLY AVE
Practice Address - Street 2:
Practice Address - City:EAST LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1605
Practice Address - Country:US
Practice Address - Phone:323-362-1010
Practice Address - Fax:323-362-1379
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA132824208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KC3232267556OtherUSC LAC