1225286479 NPI number — DR. JOHNNY C. CHEN M.D.

Table of content: DR. JOHNNY C. CHEN M.D. (NPI 1225286479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225286479 NPI number — DR. JOHNNY C. CHEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEN
Provider First Name:
JOHNNY
Provider Middle Name:
C.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1225286479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
937 E MAIN ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93454-5909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-922-1739
Provider Business Mailing Address Fax Number:
805-922-4197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 E CHURCH ST
Provider Second Line Business Practice Location Address:
MARIAN REGIONAL MEDICAL CENTER DEPT OF ANESTHESIOLOGY
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93454-5906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-739-3000
Provider Business Practice Location Address Fax Number:
805-739-3716
Provider Enumeration Date:
08/29/2008

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: 207L00000X , with the licence number:  A106527 , 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: 1225286479 . This is a "BLUE CROSS OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1225286479 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A1065270 . This is a "BLUE SHIELD FEDERAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0A1065270 . This is a "BLUE SHIELD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1225286479 . This is a "TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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