Healthcare Provider Details

I. General information

NPI: 1558406462
Provider Name (Legal Business Name): JANE W. CHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 SAMARITAN DR STE J
SAN JOSE CA
95124-4108
US

IV. Provider business mailing address

106 PLACER OAKS CT
LOS GATOS CA
95032-3410
US

V. Phone/Fax

Practice location:
  • Phone: 408-858-8151
  • Fax:
Mailing address:
  • Phone: 408-858-8151
  • Fax: 302-338-6985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA054942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: