Provider Demographics
NPI:1124018171
Name:CHEN, CHIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHIA
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 BUHNE ST
Mailing Address - Street 2:A
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3238
Mailing Address - Country:US
Mailing Address - Phone:707-443-4593
Mailing Address - Fax:707-443-6447
Practice Address - Street 1:2350 BUHNE ST
Practice Address - Street 2:A
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3238
Practice Address - Country:US
Practice Address - Phone:707-443-4593
Practice Address - Fax:707-443-6447
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61881173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A618810Medicaid
CAZZZ36729ZMedicare ID - Type Unspecified
CAH00998Medicare UPIN