Healthcare Provider Details

I. General information

NPI: 1114501673
Provider Name (Legal Business Name): YANG CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N MOLLISON AVE # 203
EL CAJON CA
92021-6159
US

IV. Provider business mailing address

505 N MOLLISON AVE # 203
EL CAJON CA
92021-6159
US

V. Phone/Fax

Practice location:
  • Phone: 619-354-4694
  • Fax:
Mailing address:
  • Phone: 619-592-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: