Provider Demographics
NPI:1770836223
Name:CHEN, XIN
Entity Type:Individual
Prefix:
First Name:XIN
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 REED AVE
Mailing Address - Street 2:C
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-2660
Mailing Address - Country:US
Mailing Address - Phone:510-673-7789
Mailing Address - Fax:
Practice Address - Street 1:542 LAKESIDE DR STE 5
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4005
Practice Address - Country:US
Practice Address - Phone:510-673-7789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15014171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist