Provider Demographics
NPI:1053484931
Name:CHEN, MICHAEL G
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:CHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 8TH ST
Mailing Address - Street 2:#201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4400
Mailing Address - Country:US
Mailing Address - Phone:510-836-6118
Mailing Address - Fax:510-836-6118
Practice Address - Street 1:259 8TH ST
Practice Address - Street 2:#201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4400
Practice Address - Country:US
Practice Address - Phone:510-836-6118
Practice Address - Fax:510-836-6118
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5570171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0055700Medicaid