Healthcare Provider Details

I. General information

NPI: 1194898239
Provider Name (Legal Business Name): PING CHEN D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4775 INDIAN SCHOOL RD NE STE 100
ALBUQUERQUE NM
87110-3927
US

IV. Provider business mailing address

6601 SONRISA PL NE
ALBUQUERQUE NM
87113-2830
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-6700
  • Fax: 505-888-6701
Mailing address:
  • Phone: 505-615-3999
  • Fax: 505-828-1617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number655
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number65-000055
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: