=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588980155
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HONG CHEN LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2010
-----------------------------------------------------
Last Update Date | 04/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2296 HENRY CLOWER BLVD #3A
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-3147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-736-3132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 990 HARBINS RD #3A
-----------------------------------------------------
City | NORCROSS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30093-4329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-736-3132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 233
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------