Healthcare Provider Details

I. General information

NPI: 1609711936
Provider Name (Legal Business Name): KYLE CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 SUNSET BLVD
CHERRYLAND CA
94541-3832
US

IV. Provider business mailing address

5148 ROWAN DR
SAN RAMON CA
94582-5977
US

V. Phone/Fax

Practice location:
  • Phone: 510-582-8311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: