Provider Demographics
NPI:1942514856
Name:CHEN, NYAN-RU
Entity Type:Individual
Prefix:
First Name:NYAN-RU
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 1:44 RICHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-2526
Mailing Address - Country:US
Mailing Address - Phone:617-323-1517
Mailing Address - Fax:
Practice Address - Street 1:1895 CENTRE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1933
Practice Address - Country:US
Practice Address - Phone:857-519-3095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237877171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist