Healthcare Provider Details

I. General information

NPI: 1952663635
Provider Name (Legal Business Name): ANUCHEAT CHEA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 REDWOOD HWY STE A-22
SAN RAFAEL CA
94903-2121
US

IV. Provider business mailing address

4340 REDWOOD HWY
SAN RAFAEL CA
94903-2121
US

V. Phone/Fax

Practice location:
  • Phone: 415-472-2343
  • Fax:
Mailing address:
  • Phone: 415-472-2343
  • Fax: 415-472-7636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA121459
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: