Provider Demographics
NPI:1053930370
Name:CHEN, MEGAN X
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:X
Last Name:CHEN
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 1:180 HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2836
Mailing Address - Country:US
Mailing Address - Phone:415-963-1567
Mailing Address - Fax:
Practice Address - Street 1:3851 KATELLA AVE STE 202
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3497
Practice Address - Country:US
Practice Address - Phone:562-206-0177
Practice Address - Fax:562-206-1576
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59309363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical