Provider Demographics
NPI:1134811300
Name:CHEN, KATHERINE G (LAC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:G
Last Name:CHEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 MISSION ST APT 1409
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-6726
Mailing Address - Country:US
Mailing Address - Phone:201-889-3898
Mailing Address - Fax:
Practice Address - Street 1:1188 MISSION ST APT 1409
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-6726
Practice Address - Country:US
Practice Address - Phone:415-371-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19726171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist