Provider Demographics
NPI:1780177766
Name:CHIEM, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:CHIEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33300 MISSION BLVD APT 73
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1446
Mailing Address - Country:US
Mailing Address - Phone:510-828-5324
Mailing Address - Fax:
Practice Address - Street 1:33300 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1463
Practice Address - Country:US
Practice Address - Phone:510-828-5324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst