Provider Demographics
NPI:1801001235
Name:CHEN, KWONG AH (LAC)
Entity Type:Individual
Prefix:
First Name:KWONG AH
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 1:4405 SILVIES WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4061
Mailing Address - Country:US
Mailing Address - Phone:530-621-2120
Mailing Address - Fax:
Practice Address - Street 1:4405 SILVIES WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-4061
Practice Address - Country:US
Practice Address - Phone:530-621-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 3565171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist