Provider Demographics
NPI:1538232475
Name:CHEN, RAY R (LAC, OMD, PHD)
Entity type:Individual
Prefix:DR
First Name:RAY
Middle Name:R
Last Name:CHEN
Suffix:
Gender:M
Credentials:LAC, OMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 N CENTRAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-7278
Mailing Address - Country:US
Mailing Address - Phone:909-946-8306
Mailing Address - Fax:909-946-1336
Practice Address - Street 1:491 N CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-7278
Practice Address - Country:US
Practice Address - Phone:909-946-8306
Practice Address - Fax:909-946-1336
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1475171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist