Provider Demographics
NPI:1093890592
Name:CHEN, BAO QIN (C A)
Entity Type:Individual
Prefix:
First Name:BAO
Middle Name:QIN
Last Name:CHEN
Suffix:
Gender:F
Credentials:C A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S ATLANTIC BLVD
Mailing Address - Street 2:206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1754
Mailing Address - Country:US
Mailing Address - Phone:323-721-5198
Mailing Address - Fax:323-721-5171
Practice Address - Street 1:212 S ATLANTIC BLVD
Practice Address - Street 2:206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1754
Practice Address - Country:US
Practice Address - Phone:323-721-5198
Practice Address - Fax:323-721-5171
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC0087330171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0087330Medicaid