Provider Demographics
NPI:1417013939
Name:CHEN, WILLIAM (LAC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1220 SIXTH AVE
Mailing Address - Street 2:STE A
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3899
Mailing Address - Country:US
Mailing Address - Phone:650-235-6761
Mailing Address - Fax:650-685-8081
Practice Address - Street 1:30 S EL CAMINO REAL
Practice Address - Street 2:#111
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3839
Practice Address - Country:US
Practice Address - Phone:650-235-6761
Practice Address - Fax:650-685-8081
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9853171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
615659000OtherFECA