Provider Demographics
NPI:1447895735
Name:CHEN, MARCUS JUSTIN
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:JUSTIN
Last Name:CHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 SLOAT BLVD STE B
Mailing Address - Street 2:#517
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1222
Mailing Address - Country:US
Mailing Address - Phone:415-508-8690
Mailing Address - Fax:
Practice Address - Street 1:2425 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3358
Practice Address - Country:US
Practice Address - Phone:415-508-8690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant