Provider Demographics
NPI:1831648526
Name:CHEN, JINGBO (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:JINGBO
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136-20 38TH AVE
Mailing Address - Street 2:SUITE 6M
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-888-1513
Mailing Address - Fax:718-886-1522
Practice Address - Street 1:136-20 38TH AVE
Practice Address - Street 2:SUITE 6M
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-888-1513
Practice Address - Fax:718-886-1522
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005496171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist