Healthcare Provider Details

I. General information

NPI: 1417880931
Provider Name (Legal Business Name): CHASEN DILLON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 SANTIAGO ST
SAN FRANCISCO CA
94116-1526
US

IV. Provider business mailing address

617 DEL NORTE ST
EUREKA CA
95501-2906
US

V. Phone/Fax

Practice location:
  • Phone: 415-241-6000
  • Fax:
Mailing address:
  • Phone: 707-502-7851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240102456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: