Basic Information
| Provider Information | |||||||||
| NPI: | 1144754623 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEN | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | IRIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4860 Y ST STE 2400 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167346891 | ||||||||
| FaxNumber: | 9167346197 | ||||||||
| Practice Location | |||||||||
| Address1: | 4860 Y ST STE 2400 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167346891 | ||||||||
| FaxNumber: | 9167346197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2017 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 57.029367 | OH | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | ME150084 | FL | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0009X | A179153 | CA | Y |
ID Information
| ID | Type | State | Issuer | Description | ME150084 | 01 | FL | FLORIDA MEDICAL LICENSE | OTHER | A179153 | 01 | CA | CALIFORNIA MEDICAL LICENSE | OTHER |