Provider Demographics
NPI:1548355423
Name:CHEN, TA FANG (OMD, LAC, QME)
Entity type:Individual
Prefix:DR
First Name:TA FANG
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:OMD, LAC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 KENWATER AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1320
Mailing Address - Country:US
Mailing Address - Phone:818-710-1566
Mailing Address - Fax:818-703-0256
Practice Address - Street 1:6314 KENWATER AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-1320
Practice Address - Country:US
Practice Address - Phone:818-710-1566
Practice Address - Fax:818-703-0256
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 2193171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0021930Medicaid