=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407983729
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL LIGUO CHEN SR. LAC OMD PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1921 S EL CAMINO REAL
-----------------------------------------------------
City | SAN MATEO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94403-1321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-573-1789
-----------------------------------------------------
Fax | 650-340-7188
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 812 PENINSULA AVE
-----------------------------------------------------
City | BURLINGAME
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-573-1789
-----------------------------------------------------
Fax | 650-340-7188
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC2458
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------