Provider Demographics
NPI:1821398702
Name:CHEN, LISA (MS MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W OLYMPIC BLVD
Mailing Address - Street 2:508
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1433
Mailing Address - Country:US
Mailing Address - Phone:707-567-3288
Mailing Address - Fax:
Practice Address - Street 1:501 W OLYMPIC BLVD
Practice Address - Street 2:508
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1433
Practice Address - Country:US
Practice Address - Phone:707-567-3288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13836171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist