Provider Demographics
NPI:1861687634
Name:CHEN, PEGGY (MD)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
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 1:1658 SOQUEL DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1706
Mailing Address - Country:US
Mailing Address - Phone:831-464-7000
Mailing Address - Fax:
Practice Address - Street 1:1658 SOQUEL DR
Practice Address - Street 2:SUITE H
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1706
Practice Address - Country:US
Practice Address - Phone:831-464-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA068794208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH19471Medicare UPIN