Healthcare Provider Details

I. General information

NPI: 1871408872
Provider Name (Legal Business Name): MS. JACQUELINE CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 12TH ST
OAKLAND CA
94607-4927
US

IV. Provider business mailing address

525 12TH ST
OAKLAND CA
94607-4927
US

V. Phone/Fax

Practice location:
  • Phone: 510-282-6794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95137993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: