Provider Demographics
NPI:1346874419
Name:CHEN, TIFFANY LILLIAN
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LILLIAN
Last Name:CHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43231 FRESCO TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5885
Mailing Address - Country:US
Mailing Address - Phone:510-512-6286
Mailing Address - Fax:
Practice Address - Street 1:43231 FRESCO TER
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5885
Practice Address - Country:US
Practice Address - Phone:510-512-6286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician