Provider Demographics
NPI:1649332743
Name:CHEN, KENNY K (MD)
Entity type:Individual
Prefix:
First Name:KENNY
Middle Name:K
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 1:2495 HOSPITAL DR, STE 650
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040
Mailing Address - Country:US
Mailing Address - Phone:650-988-8460
Mailing Address - Fax:650-988-8478
Practice Address - Street 1:2495 HOSPITAL DR
Practice Address - Street 2:SUITE 650
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040
Practice Address - Country:US
Practice Address - Phone:650-988-8460
Practice Address - Fax:650-988-8478
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH38578Medicare UPIN
CA00A679411Medicare ID - Type Unspecified