Healthcare Provider Details

I. General information

NPI: 1366410086
Provider Name (Legal Business Name): STEVEN L CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ACTIVITY RD
SAN DIEGO CA
92126-4427
US

IV. Provider business mailing address

5473 COLT TER
SAN DIEGO CA
92130-3727
US

V. Phone/Fax

Practice location:
  • Phone: 858-571-0606
  • Fax: 858-571-1933
Mailing address:
  • Phone: 858-571-0606
  • Fax: 858-571-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA90439
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA90439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: