Provider Demographics
NPI:1093168072
Name:CHEN, MING TIAN
Entity Type:Individual
Prefix:MR
First Name:MING
Middle Name:TIAN
Last Name:CHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18442 DEL BONITA ST
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4531
Mailing Address - Country:US
Mailing Address - Phone:909-610-0186
Mailing Address - Fax:
Practice Address - Street 1:382 S LEMON AVE STE B
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2715
Practice Address - Country:US
Practice Address - Phone:909-610-0186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA16384171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist