Provider Demographics
NPI:1285624213
Name:CHEN, SANDY LI-FAN (MD)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:LI-FAN
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3239 STEVENS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1145
Mailing Address - Country:US
Mailing Address - Phone:408-502-6188
Mailing Address - Fax:888-456-8575
Practice Address - Street 1:3239 STEVENS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1145
Practice Address - Country:US
Practice Address - Phone:408-502-6188
Practice Address - Fax:888-456-8575
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86645207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA86645OtherLICENSE
CAZZZ09989ZOtherBS GROUP PIN
CAA86645OtherLICENSE
CADC7365Medicare ID - Type UnspecifiedRRM GROUP
CAZZZ09989ZOtherBS GROUP PIN
CA00A866451Medicare PIN
CAA86645OtherLICENSE