IndividualActive
Jerry Chen
NPI 1083201636 · Internal Medicine Physician · San Ysidro, CA
Provider details
- NPI number
- 1083201636
- Entity type
- Individual
- Primary specialty
- Internal Medicine PhysicianAllopathic & Osteopathic Physicians
- Sex
- Male
- Sole proprietor
- Yes
- License
- DOL.OL.70108432 (WA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Profile Score
Established profile(63/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4004 Beyer Blvd
San Ysidro, CA 92173-2099
Phone: (619) 662-4100
Street-level locationGet directions
Mailing address
325 9th Ave
Seattle, WA 98104-2499
Registry dates
- Enumerated
- 2020-12-30
- Last updated
- 2026-06-04
- Certified
- 2026-06-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.