Provider Demographics
NPI:1417206632
Name:SHEN, CHIA (LAC PHD)
Entity Type:Individual
Prefix:
First Name:CHIA
Middle Name:
Last Name:SHEN
Suffix:
Gender:F
Credentials:LAC PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 15TH ST
Mailing Address - Street 2:UNIT 3025
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-7302
Mailing Address - Country:US
Mailing Address - Phone:310-866-2608
Mailing Address - Fax:
Practice Address - Street 1:126 SUMNER AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:AVALON
Practice Address - State:CA
Practice Address - Zip Code:90704-3093
Practice Address - Country:US
Practice Address - Phone:310-866-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13704133N00000X
AC13407174400000X
CAAC13407171100000X
CA20084225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AC13704OtherACUPUNCTURIST