Healthcare Provider Details

I. General information

NPI: 1013621184
Provider Name (Legal Business Name): YI CHEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 64TH ST STE 100
EMERYVILLE CA
94608-2038
US

IV. Provider business mailing address

3008 BIRCHWOOD COURT
FULLERTON CA
92835
US

V. Phone/Fax

Practice location:
  • Phone: 510-629-6682
  • Fax:
Mailing address:
  • Phone: 951-599-3182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: