Basic Information
| Provider Information | |||||||||
| NPI: | 1417167016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEN | ||||||||
| FirstName: | FONDA | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2651 BATSON AVE | ||||||||
| Address2: | |||||||||
| City: | ROWLAND HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917484519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267310506 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10800 MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925053043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513532000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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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 | 207Q00000X | 20A10003 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.