Basic Information
| Provider Information | |||||||||
| NPI: | 1285864462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEN | ||||||||
| FirstName: | YING-JU | ||||||||
| MiddleName: | ANNA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1080 PARK BLVD UNIT 1202 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921015642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195901994 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 605 FLETCHER PKWY | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920202522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195901994 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2009 | ||||||||
| LastUpdateDate: | 05/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TA2150 | MD | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 0618001879 | VA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 33872 | CA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.