MEDICARE: LUCAS IP CHEN

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	1835P0200X	Pediatric Pharmacist	79048	CA

General Provider Information

NPI Number	:	1952963175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS IP CHEN

Provider Business Mailing Address
First Line	:	970 SWEET AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-2342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 WELCH RD
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94304-1601
Country	:	US
Telephone Number	:	408-806-0892
Fax Number	:

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

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	07/09/2019

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Directions to “ LUCAS IP CHEN ” Practice Location

Language	Start Address	Practice Location

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