Provider Demographics
NPI:1609204262
Name:CHEN, ZHISONG (OMD, PHD, LAC)
Entity Type:Individual
Prefix:
First Name:ZHISONG
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:OMD, PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8818 TUCKERMAN LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3164
Mailing Address - Country:US
Mailing Address - Phone:301-820-2528
Mailing Address - Fax:
Practice Address - Street 1:8818 TUCKERMAN LN
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3164
Practice Address - Country:US
Practice Address - Phone:301-820-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-17
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01987171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist