Healthcare Provider Details

I. General information

NPI: 1669395653
Provider Name (Legal Business Name): MERCY SAN JUAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 COYLE AVE
CARMICHAEL CA
95608-0302
US

IV. Provider business mailing address

6555 COYLE AVE
CARMICHAEL CA
95608-0302
US

V. Phone/Fax

Practice location:
  • Phone: 916-536-3500
  • Fax:
Mailing address:
  • Phone: 916-536-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: YI-REN CHEN
Title or Position: PHYSICIAN
Credential: MD
Phone: 916-537-5000