Provider Demographics
NPI:1669694766
Name:CHEN, BEIRU J (MD)
Entity type:Individual
Prefix:DR
First Name:BEIRU
Middle Name:J
Last Name:CHEN
Suffix:
Gender:F
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 77800
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-1100
Mailing Address - Country:US
Mailing Address - Phone:209-477-4432
Mailing Address - Fax:209-320-6136
Practice Address - Street 1:2291 W MARCH LN
Practice Address - Street 2:SUITE 179E
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6652
Practice Address - Country:US
Practice Address - Phone:209-477-4432
Practice Address - Fax:209-320-6136
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51848207ZB0001X, 207ZC0500X, 207ZD0900X, 207ZH0000X, 207ZI0100X, 207ZM0300X, 207ZN0500X, 207ZP0102X, 207ZP0104X, 207ZP0105X, 207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
No207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABP693OtherMEDICARE PTAN
CALAB09388FMedicaid
CAP00706349OtherMEDICARE RAILROAD PTAN
CAP00706349OtherMEDICARE RAILROAD PTAN
CAH38751Medicare UPIN