Provider Demographics
NPI:1861674889
Name:CHEN, TERRY MICHAEL (LAC)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:MICHAEL
Last Name:CHEN
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:6904 LOS VERDES DR
Mailing Address - Street 2:#7
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5675
Mailing Address - Country:US
Mailing Address - Phone:310-749-5683
Mailing Address - Fax:310-514-3723
Practice Address - Street 1:1300 W 6TH ST
Practice Address - Street 2:#3
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3531
Practice Address - Country:US
Practice Address - Phone:310-514-3737
Practice Address - Fax:310-514-3723
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAAC 8665171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist