Healthcare Provider Details

I. General information

NPI: 1770517393
Provider Name (Legal Business Name): SHU-CHEN JENNIE CHENG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39500 LIBERTY ST TRI-CITY HEALTH CENTER
FREMONT CA
94538-2211
US

IV. Provider business mailing address

8173 TANFORAN CT
NEWARK CA
94560-1089
US

V. Phone/Fax

Practice location:
  • Phone: 510-770-8133
  • Fax: 510-770-8145
Mailing address:
  • Phone: 510-770-8133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNM823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: