Provider Demographics
NPI:1407127772
Name:CHEN, CHIUNG C-J (RAC)
Entity Type:Individual
Prefix:
First Name:CHIUNG
Middle Name:C-J
Last Name:CHEN
Suffix:
Gender:M
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-4507
Mailing Address - Country:US
Mailing Address - Phone:215-882-2804
Mailing Address - Fax:
Practice Address - Street 1:5235 RIDGE AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3711
Practice Address - Country:US
Practice Address - Phone:215-882-2804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000915171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist