Provider Demographics
NPI:1962502872
Name:CHEN, RANDOLPH A (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:A
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1301 SHOREWAY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-4151
Mailing Address - Country:US
Mailing Address - Phone:650-596-7000
Mailing Address - Fax:650-596-7093
Practice Address - Street 1:1301 SHOREWAY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-4151
Practice Address - Country:US
Practice Address - Phone:650-596-7000
Practice Address - Fax:650-596-7093
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2008-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA37526207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI522236-01Medicaid
HIH54955Medicare PIN
HIH74796Medicare UPIN