Provider Demographics
NPI:1285872168
Name:CHEN, I-FENG (LAC)
Entity type:Individual
Prefix:
First Name:I-FENG
Middle Name:
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 1:2707 E VALLEY BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-3140
Mailing Address - Country:US
Mailing Address - Phone:626-810-7772
Mailing Address - Fax:626-810-0304
Practice Address - Street 1:2707 E VALLEY BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3140
Practice Address - Country:US
Practice Address - Phone:626-810-7772
Practice Address - Fax:626-810-0304
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12828171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC12828OtherLICENSE