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General NPI Number Information
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NPI Number | 1801269659
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Entity Type | Organization
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Legal Business Name | CHENSTAR CORPORATION
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 46280 BRIAR PL
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City | FREMONT
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State | CA
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Zip | 94539-6866
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Country | US
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Telephone | 510-490-7311
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Fax |
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Provider Business Mailing Address
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Address Line | 46280 BRIAR PL
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City | FREMONT
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State | CA
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Zip | 94539-6866
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Country | US
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Telephone | 510-490-7311
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MOON CHIA
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Credential |
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Telephone | 510-490-7311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 1-15-18688
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License Number State | CO
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