Healthcare Provider Details

I. General information

NPI: 1861766255
Provider Name (Legal Business Name): EAST BAY CARDIOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 04/22/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39229 LIBERTY STREET
FREMONT CA
94538-1501
US

IV. Provider business mailing address

39229 LIBERTY ST
FREMONT CA
94538-1501
US

V. Phone/Fax

Practice location:
  • Phone: 510-494-8316
  • Fax: 510-494-8314
Mailing address:
  • Phone: 510-494-8316
  • Fax: 510-494-8314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KWAN SIAN CHEN
Title or Position: OWNER
Credential: MD
Phone: 510-494-8316