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General NPI Number Information
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NPI Number | 1114266574
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Entity Type | Individual
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Provider Name | JEREMY CHEN
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Gender | Male
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 02/05/2013
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Provider Practice Location Address
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Address Line | 5200 N. ROSEMEAD BLVD
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City | SAN GABRIEL
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State | CA
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Zip | 91776
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Country | US
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Telephone | 626-677-0380
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Fax |
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Provider Business Mailing Address
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Address Line | 1855 PALMAS DR
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City | SAN MARINO
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State | CA
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Zip | 91108-2550
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 14744
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License Number State | CA
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