Healthcare Provider Details

I. General information

NPI: 1558855437
Provider Name (Legal Business Name): STEPHEN S CHEN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 BOTELHO DR STE 110
WALNUT CREEK CA
94596-5083
US

IV. Provider business mailing address

6114 LA SALLE AVE # 320
OAKLAND CA
94611-2802
US

V. Phone/Fax

Practice location:
  • Phone: 925-934-3536
  • Fax: 925-934-0672
Mailing address:
  • Phone: 415-491-1210
  • Fax: 415-491-4647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA107350
License Number StateCA

VIII. Authorized Official

Name: MARGARET A RASKOWSKY
Title or Position: MANAGER
Credential:
Phone: 415-491-1210