Provider Demographics
NPI:1083721799
Name:CHEN, JING (LAC OMD)
Entity Type:Individual
Prefix:DR
First Name:JING
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:LAC OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11681 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91754
Mailing Address - Country:US
Mailing Address - Phone:626-289-2298
Mailing Address - Fax:323-981-9982
Practice Address - Street 1:2063 S ATLANTIC BLVD
Practice Address - Street 2:SUITE #B
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754
Practice Address - Country:US
Practice Address - Phone:626-289-2298
Practice Address - Fax:323-981-9982
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3761171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist