MEDICARE: CHERYL TIEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	103T00000X	Psychologist	PSB94027247	CA

General Provider Information

NPI Number	:	1639576143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL TIEN

Provider Business Mailing Address
First Line	:	582 MARKET ST STE 1203
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-5313
Country	:	US
Telephone Number	:	415-343-5890
Fax Number	:

Provider Business Practice Location Address
First Line	:	582 MARKET ST STE 1203
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-5313
Country	:	US
Telephone Number	:	415-343-5890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2014
Last Update Date	:	11/28/2022

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Directions to “ CHERYL TIEN ” Practice Location

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