Healthcare Provider Details

I. General information

NPI: 1114471240
Provider Name (Legal Business Name): TENZIN DECHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 GRAND AVE
OAKLAND CA
94610-4724
US

IV. Provider business mailing address

1400 ADDISON ST
BERKELEY CA
94702-1903
US

V. Phone/Fax

Practice location:
  • Phone: 510-835-2777
  • Fax:
Mailing address:
  • Phone: 510-501-2946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: