Provider Demographics
NPI:1871697250
Name:CHEN, ERIC M W (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M W
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14050 CHERRY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-0766
Mailing Address - Country:US
Mailing Address - Phone:909-823-5220
Mailing Address - Fax:909-823-7650
Practice Address - Street 1:14050 CHERRY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-8312
Practice Address - Country:US
Practice Address - Phone:909-823-5220
Practice Address - Fax:909-823-7650
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2016-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA36192207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A361920Medicare PIN
CAA88368Medicare UPIN