Healthcare Provider Details

I. General information

NPI: 1265810337
Provider Name (Legal Business Name): ALICE I-CHI CHEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

9500 GILMAN DR # MC0980
LA JOLLA CA
92093-0980
US

V. Phone/Fax

Practice location:
  • Phone: 844-747-0474
  • Fax: 858-334-4641
Mailing address:
  • Phone: 844-747-0474
  • Fax: 858-334-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number20A16077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: