Provider Demographics
NPI:1558855437
Name:STEPHEN S CHEN MD INC
Entity Type:Organization
Organization Name:STEPHEN S CHEN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:RASKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-491-1210
Mailing Address - Street 1:6114 LA SALLE AVE # 320
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2802
Mailing Address - Country:US
Mailing Address - Phone:415-491-1210
Mailing Address - Fax:415-491-4647
Practice Address - Street 1:1777 BOTELHO DR STE 110
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5083
Practice Address - Country:US
Practice Address - Phone:925-934-3536
Practice Address - Fax:925-934-0672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107350207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty