Healthcare Provider Details

I. General information

NPI: 1467106542
Provider Name (Legal Business Name): AIDA CHEN ZHU DACM. MSTOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8710 RALPH ST
ROSEMEAD CA
91770-1737
US

IV. Provider business mailing address

8710 RALPH ST
ROSEMEAD CA
91770-1737
US

V. Phone/Fax

Practice location:
  • Phone: 860-970-8480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: