Healthcare Provider Details

I. General information

NPI: 1124018171
Provider Name (Legal Business Name): CHIA CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 BUHNE ST A
EUREKA CA
95501-3238
US

IV. Provider business mailing address

2350 BUHNE ST A
EUREKA CA
95501-3238
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-4593
  • Fax: 707-443-6447
Mailing address:
  • Phone: 707-443-4593
  • Fax: 707-443-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA61881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: