Provider Demographics
NPI:1386685444
Name:CHEN, JI JILL (MD)
Entity Type:Individual
Prefix:
First Name:JI
Middle Name:JILL
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 1:3260 SACRAMENTO ST
Mailing Address - Street 2:OVER 60 HEALTH CENTER
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2739
Mailing Address - Country:US
Mailing Address - Phone:510-601-6060
Mailing Address - Fax:
Practice Address - Street 1:3260 SACRAMENTO ST
Practice Address - Street 2:OVER 60 HEALTH CENTER
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2739
Practice Address - Country:US
Practice Address - Phone:510-601-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI34967Medicare UPIN