Provider Demographics
NPI:1558979773
Name:CHEN, LIANG (CLA)
Entity Type:Individual
Prefix:
First Name:LIANG
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:CLA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 S 11TH ST UNIT 230
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2477
Mailing Address - Country:US
Mailing Address - Phone:408-818-0213
Mailing Address - Fax:
Practice Address - Street 1:952 S 11TH ST UNIT 230
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2477
Practice Address - Country:US
Practice Address - Phone:408-818-0213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18439171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist