Healthcare Provider Details

I. General information

NPI: 1528222684
Provider Name (Legal Business Name): PAULA CHEN LAC OMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1491 CEDARWOOD LANE #D
PLEASANTON CA
94566
US

IV. Provider business mailing address

1393 SANTA RITA RD STE D
PLEASANTON CA
94566
US

V. Phone/Fax

Practice location:
  • Phone: 925-461-2840
  • Fax: 925-461-2844
Mailing address:
  • Phone: 925-461-2840
  • Fax: 925-461-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: