Provider Demographics
NPI:1821012691
Name:CHEN, FULTON SHEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:FULTON
Middle Name:SHEEN
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:PO BOX 2730
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95015-2730
Mailing Address - Country:US
Mailing Address - Phone:510-739-1922
Mailing Address - Fax:510-739-1925
Practice Address - Street 1:1999 MOWRY AVE STE S
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1723
Practice Address - Country:US
Practice Address - Phone:510-739-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55609208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A556090Medicare ID - Type UnspecifiedMEDICARE NUMBER
CAG92327Medicare UPIN