Provider Demographics
NPI:1235802307
Name:AI, WEN-CHEN (LAC)
Entity Type:Individual
Prefix:
First Name:WEN-CHEN
Middle Name:
Last Name:AI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N EASTMAN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-3375
Mailing Address - Country:US
Mailing Address - Phone:903-757-0620
Mailing Address - Fax:903-753-7196
Practice Address - Street 1:1800 N EASTMAN RD STE 2
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3375
Practice Address - Country:US
Practice Address - Phone:903-757-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC02033171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist