Provider Demographics
NPI:1609271477
Name:JEN, VIE (LAC)
Entity Type:Individual
Prefix:
First Name:VIE
Middle Name:
Last Name:JEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:VIE
Other - Middle Name:
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2107D W COMMONWEALTH AVE # 371
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-1403
Mailing Address - Country:US
Mailing Address - Phone:626-476-5639
Mailing Address - Fax:
Practice Address - Street 1:146 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3431
Practice Address - Country:US
Practice Address - Phone:626-808-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15779171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist