Provider Demographics
NPI:1649251661
Name:CHEN, NAILI ALEXANDER (DO, MPH, MASC)
Entity type:Individual
Prefix:DR
First Name:NAILI
Middle Name:ALEXANDER
Last Name:CHEN
Suffix:
Gender:M
Credentials:DO, MPH, MASC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-539-9582
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-539-9582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-009459-L207R00000X
CA20A7408207PE0004X, 2083A0100X, 2083P0500X, 207R00000X
PAOS-009459L208M00000X
CA20A7048208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A7408OtherBLUE CROSS OF CALIFORNIA
CAFC1139105OtherDEA-CIVILIAN (CURRENT & ACTIVE)
CA20A7408OtherBLUE CROSS OF CALIFORNIA
FLBC7565421OtherOLD MILITARY DEA # (INACTIVE)
MDFC1841091OtherDEA-MILITARY (CURRENT & ACTIVE)