Provider Demographics
NPI:1205451572
Name:CHEN, KODY ERIC (LAC)
Entity type:Individual
Prefix:
First Name:KODY
Middle Name:ERIC
Last Name:CHEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 HUDNUT LN
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-4335
Mailing Address - Country:US
Mailing Address - Phone:908-566-2941
Mailing Address - Fax:
Practice Address - Street 1:100 CABOT DR STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08691-3202
Practice Address - Country:US
Practice Address - Phone:609-528-4417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00140000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist