Provider Demographics
NPI:1023558830
Name:CHEN, XI (MA)
Entity Type:Individual
Prefix:
First Name:XI
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 DOW AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7247
Mailing Address - Country:US
Mailing Address - Phone:949-328-7688
Mailing Address - Fax:949-328-7689
Practice Address - Street 1:3002 DOW AVE STE 122
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7247
Practice Address - Country:US
Practice Address - Phone:949-328-7688
Practice Address - Fax:949-328-7689
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT95119106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist