Healthcare Provider Details

I. General information

NPI: 1669694766
Provider Name (Legal Business Name): BEIRU J. CHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2291 W MARCH LN SUITE 179E
STOCKTON CA
95207-6652
US

IV. Provider business mailing address

PO BOX 77800
STOCKTON CA
95267-1100
US

V. Phone/Fax

Practice location:
  • Phone: 209-477-4432
  • Fax: 209-320-6136
Mailing address:
  • Phone: 209-477-4432
  • Fax: 209-320-6136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberC51848
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberC51848
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberC51848
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberC51848
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License NumberC51848
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License NumberC51848
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License NumberC51848
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberC51848
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code207ZP0104X
TaxonomyChemical Pathology Physician
License NumberC51848
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberC51848
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License NumberC51848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: