Basic Information
| Provider Information | |||||||||
| NPI: | 1225286479 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEN | ||||||||
| FirstName: | JOHNNY | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 937 E MAIN ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934545909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059221739 | ||||||||
| FaxNumber: | 8059224197 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 E CHURCH ST | ||||||||
| Address2: | MARIAN REGIONAL MEDICAL CENTER DEPT OF ANESTHESIOLOGY | ||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934545906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037393000 | ||||||||
| FaxNumber: | 8057393716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2008 | ||||||||
| LastUpdateDate: | 02/26/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A106527 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 1225286479 | 01 | CA | BLUE CROSS OF CA | OTHER | 1225286479 | 05 | CA | MEDICAID | 00A1065270 | 01 | CA | BLUE SHIELD FEDERAL | OTHER | 0A1065270 | 01 | CA | BLUE SHIELD OF CA | OTHER | 1225286479 | 01 | CA | TRICARE | OTHER |