Healthcare Provider Details

I. General information

NPI: 1922178318
Provider Name (Legal Business Name): VICKI LYNN CHEW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E MARCH LN STE 360
STOCKTON CA
95210-6675
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 209-951-1178
  • Fax:
Mailing address:
  • Phone: 209-956-7732
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG61098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: