Provider Demographics
NPI:1720392418
Name:CHEN, MENG (LAC)
Entity Type:Individual
Prefix:MR
First Name:MENG
Middle Name:
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 1:215 E DAILY DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5805
Mailing Address - Country:US
Mailing Address - Phone:805-200-6301
Mailing Address - Fax:
Practice Address - Street 1:215 E DAILY DR
Practice Address - Street 2:SUITE 12
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5805
Practice Address - Country:US
Practice Address - Phone:805-200-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12435171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist