Provider Demographics
NPI:1598087512
Name:CHEN, KAN LIN (LAC, MAOM)
Entity Type:Individual
Prefix:
First Name:KAN
Middle Name:LIN
Last Name:CHEN
Suffix:
Gender:M
Credentials:LAC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 WASHINGTON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-6418
Mailing Address - Country:US
Mailing Address - Phone:781-235-1038
Mailing Address - Fax:
Practice Address - Street 1:572 WASHINGTON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-6418
Practice Address - Country:US
Practice Address - Phone:781-235-1038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238028171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA238028OtherACUPUNCTURE LICENSE