Provider Demographics
NPI:1801201389
Name:CHEN, ALYCIA (DPM)
Entity Type:Individual
Prefix:
First Name:ALYCIA
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SOUTH DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040
Mailing Address - Country:US
Mailing Address - Phone:415-939-0073
Mailing Address - Fax:
Practice Address - Street 1:305 SOUTH DR STE 6
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4207
Practice Address - Country:US
Practice Address - Phone:650-215-8722
Practice Address - Fax:650-964-0720
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5391213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE5391OtherCALIFORNIA BOARD OF PODIATRIC MEDICINE