Provider Demographics
NPI:1174575062
Name:CHEN, CHI-CHUN (CA NCCAOM)
Entity type:Individual
Prefix:MS
First Name:CHI-CHUN
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:CA NCCAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 NATIONAL BLVD
Mailing Address - Street 2:STE 607
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4139
Mailing Address - Country:US
Mailing Address - Phone:310-880-5306
Mailing Address - Fax:
Practice Address - Street 1:10801 NATIONAL BLVD
Practice Address - Street 2:#607
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064
Practice Address - Country:US
Practice Address - Phone:310-880-5306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7633171100000X
15861171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist