Provider Demographics
NPI:1124019153
Name:CHEN, KELLY MAY (MS, CGC)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MAY
Last Name:CHEN
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 OPTICAL CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-1400
Mailing Address - Country:US
Mailing Address - Phone:669-786-0116
Mailing Address - Fax:
Practice Address - Street 1:5901 OPTICAL CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138-1400
Practice Address - Country:US
Practice Address - Phone:669-786-0116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS