Provider Demographics
NPI:1972967982
Name:CHEN, ANNA KOBLIK (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:KOBLIK
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:OLEGOVNA
Other - Last Name:KOBLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:18601 FM 1431
Mailing Address - Street 2:STE 104 #1015
Mailing Address - City:JONESTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78645-3222
Mailing Address - Country:US
Mailing Address - Phone:415-379-0282
Mailing Address - Fax:
Practice Address - Street 1:475 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5287
Practice Address - Country:US
Practice Address - Phone:415-379-0282
Practice Address - Fax:310-439-3701
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01091921A2084N0400X
CAA1532702084N0400X, 2084N0600X
NY3267992084N0600X
KS04-467982084N0600X
ARE-158002084N0600X
OK398832084N0600X
MO20220398952084N0600X
TXT96572084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology