Provider Demographics
NPI:1124217088
Name:CHEN, CHIH M (LAC)
Entity Type:Individual
Prefix:DR
First Name:CHIH
Middle Name:M
Last Name:CHEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:DR
Other - First Name:ROBBINSON
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:1095 NORTH D STREET
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410
Mailing Address - Country:US
Mailing Address - Phone:909-888-7649
Mailing Address - Fax:909-888-1955
Practice Address - Street 1:1095 NORTH D STREET
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410
Practice Address - Country:US
Practice Address - Phone:909-888-7649
Practice Address - Fax:909-888-1955
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1271171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist