Healthcare Provider Details

I. General information

NPI: 1316697386
Provider Name (Legal Business Name): HUMAN LONGEVITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GATEWAY BLVD STE 101
SOUTH SAN FRANCISCO CA
94080-7014
US

IV. Provider business mailing address

600 GATEWAY BLVD STE 101
SOUTH SAN FRANCISCO CA
94080-7014
US

V. Phone/Fax

Practice location:
  • Phone: 844-838-3322
  • Fax: 858-430-2741
Mailing address:
  • Phone: 844-838-3322
  • Fax: 858-430-2741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIE CHEN
Title or Position: CHIEF CLINICAL OFFICER
Credential: MD
Phone: 949-394-3551