Healthcare Provider Details

I. General information

NPI: 1932660966
Provider Name (Legal Business Name): EILEEN CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 10/01/2022
Certification Date: 10/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST ST STE 400
SAN DIEGO CA
92123-2753
US

IV. Provider business mailing address

7910 FROST ST STE 400
SAN DIEGO CA
92123-2753
US

V. Phone/Fax

Practice location:
  • Phone: 858-495-0500
  • Fax:
Mailing address:
  • Phone: 858-495-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA179023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: