Healthcare Provider Details

I. General information

NPI: 1629458609
Provider Name (Legal Business Name): MIAO-CHIN CHEN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N BELLFLOWER BLVD STE 116
LONG BEACH CA
90815-1100
US

IV. Provider business mailing address

4444 PEPPERWOOD AVE
LONG BEACH CA
90808-1348
US

V. Phone/Fax

Practice location:
  • Phone: 562-888-3399
  • Fax: 562-567-7881
Mailing address:
  • Phone: 562-316-8808
  • Fax: 562-567-7881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number10245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: