Provider Demographics
NPI:1366404469
Name:CHEN, JANET (MD,)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 OAK PARK BLVD
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3264
Mailing Address - Country:US
Mailing Address - Phone:805-489-8286
Mailing Address - Fax:805-489-7376
Practice Address - Street 1:921 OAK PARK BLVD
Practice Address - Street 2:SUITE 201B
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3264
Practice Address - Country:US
Practice Address - Phone:805-489-8286
Practice Address - Fax:805-489-7376
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69459207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA180032550OtherRAILROAD MEDICARE
CA00G694590Medicaid
CAWG69459AMedicare ID - Type UnspecifiedMEDICARE PROVIDER
CAF65017Medicare UPIN