Provider Demographics
NPI:1528366325
Name:CHEN, BRIAN C (LAC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:CHEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 SLOAT RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1231
Mailing Address - Country:US
Mailing Address - Phone:408-306-4118
Mailing Address - Fax:
Practice Address - Street 1:650 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4113
Practice Address - Country:US
Practice Address - Phone:408-306-4118
Practice Address - Fax:510-401-1239
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13534171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist