Healthcare Provider Details

I. General information

NPI: 1215626056
Provider Name (Legal Business Name): YUNG FEN CHEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEMI CHEN OD

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MINOR HALL
BERKELEY CA
94720-0001
US

IV. Provider business mailing address

681 HANOVER DR
BRENTWOOD CA
94513-2398
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT35471-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: