Healthcare Provider Details

I. General information

NPI: 1215456090
Provider Name (Legal Business Name): XIALI CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 09/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 EMBARCADERO STE 400
OAKLAND CA
94606-5300
US

IV. Provider business mailing address

1583 151ST AVE
SAN LEANDRO CA
94578-1953
US

V. Phone/Fax

Practice location:
  • Phone: 510-567-8101
  • Fax:
Mailing address:
  • Phone: 510-285-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number33717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: