Provider Demographics
NPI:1588617658
Name:CHEN, FANG KUN (LAC)
Entity Type:Individual
Prefix:MR
First Name:FANG
Middle Name:KUN
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 1:3620 NE 122ND AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1365
Mailing Address - Country:US
Mailing Address - Phone:503-255-2618
Mailing Address - Fax:503-261-0049
Practice Address - Street 1:3620 NE 122ND AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1365
Practice Address - Country:US
Practice Address - Phone:503-255-2618
Practice Address - Fax:503-261-0049
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00346171100000X
OR3897225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
230750Medicare ID - Type Unspecified