Healthcare Provider Details

I. General information

NPI: 1841004363
Provider Name (Legal Business Name): KAISER L CHEN AGACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CHELSEA WAY
CORONA CA
92879-5880
US

IV. Provider business mailing address

550 CHELSEA WAY
CORONA CA
92879-5880
US

V. Phone/Fax

Practice location:
  • Phone: 951-818-5679
  • Fax:
Mailing address:
  • Phone: 951-818-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95033663
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number4211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: