Provider Demographics
NPI:1992506836
Name:CHEN, MIN
Entity type:Individual
Prefix:
First Name:MIN
Middle Name:
Last Name:CHEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 MAUD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5245
Mailing Address - Country:US
Mailing Address - Phone:510-816-7967
Mailing Address - Fax:
Practice Address - Street 1:34460 FREMONT BLVD STE B
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-3324
Practice Address - Country:US
Practice Address - Phone:510-792-4742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH90581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist