1386089068 NPI number — ERICA CUA CHEN M.D.

Table of content: ERICA CUA CHEN M.D. (NPI 1386089068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386089068 NPI number — ERICA CUA CHEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEN
Provider First Name:
ERICA
Provider Middle Name:
CUA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CUA
Provider Other First Name:
ERICA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386089068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
435 SEFTON AVE UNIT D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEREY PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91755-4414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-375-2385
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8001 VENTURA CANYON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANORAMA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-574-2273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A132467 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: A132467 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207K00000X , with the licence number: A132467 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: EC3232267556 . This is a "EC3232267556" identifier . This identifiers is of the category "OTHER".