Basic Information
| Provider Information | |||||||||
| NPI: | 1649251661 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEN | ||||||||
| FirstName: | NAILI | ||||||||
| MiddleName: | ALEXANDER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O., MPH, MASC | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3551 ROGER BROOKE DR | ||||||||
| Address2: | |||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105399582 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3551 ROGER BROOKE DR | ||||||||
| Address2: | |||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105399582 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS-009459-L | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207PE0004X | 20A7408 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 2083A0100X | 20A7408 | CA | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine | 2083P0500X | 20A7408 | CA | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine | 208M00000X | OS-009459L | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 20A7048 | CA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 20A7408 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | BC6266781 | 01 | PA | OLD CIVILIAN DEA # (INACTIVE) | OTHER | FC1139105 | 01 | CA | DEA-CIVILIAN (CURRENT & ACTIVE) | OTHER | 20A7408 | 01 | CA | BLUE CROSS OF CALIFORNIA | OTHER | BC7565421 | 01 | FL | OLD MILITARY DEA # (INACTIVE) | OTHER | FC1841091 | 01 | MD | DEA-MILITARY (CURRENT & ACTIVE) | OTHER |