Provider Demographics
NPI:1598840175
Name:CHEN, KENNETH Z (DPM)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:Z
Last Name:CHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S SAN MATEO DR STE 488
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3833
Mailing Address - Country:US
Mailing Address - Phone:650-342-0807
Mailing Address - Fax:650-342-0821
Practice Address - Street 1:50 S SAN MATEO DR STE 488
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3833
Practice Address - Country:US
Practice Address - Phone:650-342-0807
Practice Address - Fax:650-342-0821
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2965213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11533Medicare UPIN