Provider Demographics
NPI:1053451930
Name:CHEN, GARY (OMD, CA)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:OMD, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N EL CAMINO REAL,
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2811
Mailing Address - Country:US
Mailing Address - Phone:760-634-1440
Mailing Address - Fax:760-634-3682
Practice Address - Street 1:317 N EL CAMINO REAL
Practice Address - Street 2:SUITE 106
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2811
Practice Address - Country:US
Practice Address - Phone:760-634-1440
Practice Address - Fax:760-634-3682
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3251171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist