Healthcare Provider Details

I. General information

NPI: 1538636030
Provider Name (Legal Business Name): PETER CHEN MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 W HEDDING ST STE 201
SAN JOSE CA
95128-1428
US

IV. Provider business mailing address

2007 W HEDDING ST STE 201
SAN JOSE CA
95128-1428
US

V. Phone/Fax

Practice location:
  • Phone: 866-375-2437
  • Fax:
Mailing address:
  • Phone: 866-375-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-57621
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: