Provider Demographics
NPI:1578780904
Name:CHEN, ALICE C (MS LAC)
Entity Type:Individual
Prefix:MISS
First Name:ALICE
Middle Name:C
Last Name:CHEN
Suffix:
Gender:F
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 E BASSETT WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5710
Mailing Address - Country:US
Mailing Address - Phone:714-860-0015
Mailing Address - Fax:
Practice Address - Street 1:1830 E BASSETT WAY
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5710
Practice Address - Country:US
Practice Address - Phone:714-860-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11736171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist