Provider Demographics
NPI:1619928025
Name:CHEN, KWAN SIAN (MD)
Entity Type:Individual
Prefix:MR
First Name:KWAN
Middle Name:SIAN
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39229 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1501
Mailing Address - Country:US
Mailing Address - Phone:510-494-8316
Mailing Address - Fax:510-494-8314
Practice Address - Street 1:39229 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1501
Practice Address - Country:US
Practice Address - Phone:510-494-8316
Practice Address - Fax:510-494-8314
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA045567207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A455671Medicaid
CAF28249Medicare UPIN
CA00A455671Medicaid