Provider Demographics
NPI:1679575336
Name:CHEN, KOUNG Y (MD)
Entity type:Individual
Prefix:DR
First Name:KOUNG
Middle Name:Y
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16415 COLORADO AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5035
Mailing Address - Country:US
Mailing Address - Phone:562-634-6341
Mailing Address - Fax:562-634-8949
Practice Address - Street 1:16415 COLORADO AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5035
Practice Address - Country:US
Practice Address - Phone:562-634-6341
Practice Address - Fax:562-634-8949
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31723208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A317230Medicaid
CAA84254Medicare UPIN
CAA31723Medicare ID - Type Unspecified