Healthcare Provider Details

I. General information

NPI: 1780019117
Provider Name (Legal Business Name): MAYLIN HEAV-WONG CHEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 STRATHMORE PL
LOS GATOS CA
95032-1758
US

IV. Provider business mailing address

105 STRATHMORE PL
LOS GATOS CA
95032-1758
US

V. Phone/Fax

Practice location:
  • Phone: 626-278-5750
  • Fax:
Mailing address:
  • Phone: 626-278-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60786223
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342239-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: