Provider Demographics
NPI:1649704883
Name:CHEN, DAVID (OMD, LAC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 PACIFIC COAST HWY
Mailing Address - Street 2:#103 & #104
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2631
Mailing Address - Country:US
Mailing Address - Phone:310-326-1008
Mailing Address - Fax:
Practice Address - Street 1:2018 PACIFIC COAST HWY
Practice Address - Street 2:#103 & #104
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2631
Practice Address - Country:US
Practice Address - Phone:310-326-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4841171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255862165OtherTYPE 2 NPI