Healthcare Provider Details

I. General information

NPI: 1356463319
Provider Name (Legal Business Name): ELLEN C.L. CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9049 BROADWAY TER
OAKLAND CA
94611-1946
US

IV. Provider business mailing address

9049 BROADWAY TER
OAKLAND CA
94611-1946
US

V. Phone/Fax

Practice location:
  • Phone: 510-923-9320
  • Fax: 510-647-1200
Mailing address:
  • Phone: 510-923-9320
  • Fax: 510-647-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA79824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: