Provider Demographics
NPI:1043227192
Name:ANDY CHEN M.D. A,MEDICAL CORPORATION
Entity type:Organization
Organization Name:ANDY CHEN M.D. A,MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:YENYU
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-552-5000
Mailing Address - Street 1:1101 N PACIFIC AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-4313
Mailing Address - Country:US
Mailing Address - Phone:818-552-5000
Mailing Address - Fax:818-552-2959
Practice Address - Street 1:1101 N PACIFIC AVE STE 104
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-4313
Practice Address - Country:US
Practice Address - Phone:818-552-5000
Practice Address - Fax:818-552-2959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA64741OtherLICENSE
CABC5969300OtherDEA #
CABC5969300OtherDEA #