Healthcare Provider Details

I. General information

NPI: 1285602573
Provider Name (Legal Business Name): RICHARD D CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MARBLE WAY
PETALUMA CA
94954-8594
US

IV. Provider business mailing address

801 MARBLE WAY
PETALUMA CA
94954-8594
US

V. Phone/Fax

Practice location:
  • Phone: 707-636-4363
  • Fax: 844-268-1466
Mailing address:
  • Phone: 707-636-4363
  • Fax: 844-268-1466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberG78024
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG78024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: