Healthcare Provider Details

I. General information

NPI: 1831386846
Provider Name (Legal Business Name): CHARLENE CHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 VAN NESS AVE FL 6
SAN FRANCISCO CA
94109
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-5760
  • Fax: 415-369-1208
Mailing address:
  • Phone: 415-600-5760
  • Fax: 415-369-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA96458
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberA96458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: