Provider Demographics
NPI:1871751115
Name:JANA CHEN, O.D., APC
Entity type:Organization
Organization Name:JANA CHEN, O.D., APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-591-5438
Mailing Address - Street 1:4143 RIVERSIDE DR
Mailing Address - Street 2:STE C
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3126
Mailing Address - Country:US
Mailing Address - Phone:909-591-5438
Mailing Address - Fax:909-591-5432
Practice Address - Street 1:4143 RIVERSIDE DR
Practice Address - Street 2:STE C
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3126
Practice Address - Country:US
Practice Address - Phone:909-591-5438
Practice Address - Fax:909-591-5432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11618TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871751115Medicaid
1871751115Medicare NSC
CASD0116180Medicare PIN