Healthcare Provider Details

I. General information

NPI: 1972967982
Provider Name (Legal Business Name): ANNA KOBLIK CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA OLEGOVNA KOBLIK MD

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 WASHINGTON BLVD
MARINA DEL REY CA
90292-5287
US

IV. Provider business mailing address

18601 FM 1431 STE 104 #1015
JONESTOWN TX
78645-3222
US

V. Phone/Fax

Practice location:
  • Phone: 415-379-0282
  • Fax: 310-439-3701
Mailing address:
  • Phone: 415-379-0282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01091921A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA153270
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number326799
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number04-46798
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberE-15800
License Number StateAR
# 6
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number39883
License Number StateOK
# 7
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberA153270
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number2022039895
License Number StateMO
# 9
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberT9657
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: