Healthcare Provider Details

I. General information

NPI: 1245438126
Provider Name (Legal Business Name): IAN CHEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 06/22/2025
Certification Date: 06/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 N ST STE N
SACRAMENTO CA
95816-5712
US

IV. Provider business mailing address

2108 N ST STE N
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 657-207-0809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number58.002280
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A21187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: