Healthcare Provider Details

I. General information

NPI: 1942053178
Provider Name (Legal Business Name): CHI QIAN CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 LINERAS WAY
SACRAMENTO CA
95823-5011
US

IV. Provider business mailing address

4515 LINERAS WAY
SACRAMENTO CA
95823-5011
US

V. Phone/Fax

Practice location:
  • Phone: 916-701-1629
  • Fax:
Mailing address:
  • Phone: 916-701-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: