Provider Demographics
NPI:1316274343
Name:CHEN, PEGGY (OMD)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 WALNUT AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6944
Mailing Address - Country:US
Mailing Address - Phone:714-838-7575
Mailing Address - Fax:714-242-6968
Practice Address - Street 1:2512 WALNUT AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6944
Practice Address - Country:US
Practice Address - Phone:714-838-7575
Practice Address - Fax:714-242-6968
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12845171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist