Provider Demographics
NPI:1780974048
Name:CHEN, JONATHAN HOU CHI (LAC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:HOU CHI
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 1:621 E CAMPBELL AVE STE 16B
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2138
Mailing Address - Country:US
Mailing Address - Phone:408-378-0547
Mailing Address - Fax:
Practice Address - Street 1:621 E CAMPBELL AVE STE 16B
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2138
Practice Address - Country:US
Practice Address - Phone:408-378-0547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14259171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist