Provider Demographics
NPI:1659855005
Name:CHEN, SONG (NP)
Entity Type:Individual
Prefix:MS
First Name:SONG
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1823
Mailing Address - Country:US
Mailing Address - Phone:510-351-6363
Mailing Address - Fax:510-278-3757
Practice Address - Street 1:27206 CALAROGA AVE
Practice Address - Street 2:205
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4300
Practice Address - Country:US
Practice Address - Phone:510-670-1111
Practice Address - Fax:510-670-4772
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009973363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily