1124019153 NPI number — MS. KELLY MAY CHEN M.S., C.G.C.

Table of content: MS. KELLY MAY CHEN M.S., C.G.C. (NPI 1124019153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124019153 NPI number — MS. KELLY MAY CHEN M.S., C.G.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEN
Provider First Name:
KELLY
Provider Middle Name:
MAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., C.G.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124019153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
STANFORD HOSPITAL, DEPT PEDIATRICS, DIVISION GENETICS
Provider Second Line Business Mailing Address:
300 PASTEUR DRIVE, ROOM H-315
Provider Business Mailing Address City Name:
STANFORD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94305-5208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-725-6628
Provider Business Mailing Address Fax Number:
650-724-1394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STANFORD HOSPITAL, DEPT PEDIATRICS, DIVISION GENETICS
Provider Second Line Business Practice Location Address:
300 PASTEUR DRIVE, ROOM H-315
Provider Business Practice Location Address City Name:
STANFORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94305-5208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-725-6628
Provider Business Practice Location Address Fax Number:
650-724-1394
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170300000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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