Healthcare Provider Details

I. General information

NPI: 1093168072
Provider Name (Legal Business Name): MR. MING TIAN CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 S LEMON AVE STE B
WALNUT CA
91789-2715
US

IV. Provider business mailing address

18442 DEL BONITA ST
ROWLAND HEIGHTS CA
91748-4531
US

V. Phone/Fax

Practice location:
  • Phone: 909-610-0186
  • Fax:
Mailing address:
  • Phone: 909-610-0186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCA16384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: