Provider Demographics
NPI:1942520630
Name:CHEN, JACLYN J (MD)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:J
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:510-204-8168
Mailing Address - Fax:510-506-7725
Practice Address - Street 1:350 30TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-204-8168
Practice Address - Fax:510-506-7725
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2022-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA120533208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA120533OtherSTATE MEDICAL LICENSE