1184621666 NPI number — ABRAHAM CHEN, D.O., INC

Table of content: DR. KEVIN CHACKO VARGHESE DO (NPI 1477181071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184621666 NPI number — ABRAHAM CHEN, D.O., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABRAHAM CHEN, D.O., INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184621666
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10995 EUCALYPTUS STREET
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91730-7687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-466-6310
Provider Business Mailing Address Fax Number:
909-466-6325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10995 EUCALYPTUS STREET
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91730-7687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-466-6310
Provider Business Practice Location Address Fax Number:
909-466-6325
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
ABRAHAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-466-6310

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20A7871 . This is a "CALIFORNIA LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00AX78710 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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