Healthcare Provider Details

I. General information

NPI: 1205578119
Provider Name (Legal Business Name): CHENGAN TONY CHIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 SAMARITAN DR STE 820
SAN JOSE CA
95124-4109
US

IV. Provider business mailing address

973 UNIVERSITY AVE
LOS GATOS CA
95032-7636
US

V. Phone/Fax

Practice location:
  • Phone: 408-871-3400
  • Fax:
Mailing address:
  • Phone: 408-871-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA197716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: