Provider Demographics
NPI:1346300449
Name:CHEN, SHANNA (LAC)
Entity type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15501 SAN FERNANDO MISSION BLVD
Mailing Address - Street 2:#104
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1359
Mailing Address - Country:US
Mailing Address - Phone:818-363-9178
Mailing Address - Fax:818-322-1316
Practice Address - Street 1:15501 SAN FERNANDO MISSION BLVD
Practice Address - Street 2:#104
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1359
Practice Address - Country:US
Practice Address - Phone:818-363-9178
Practice Address - Fax:818-322-1316
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4883171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0048830Medicare ID - Type Unspecified