Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 20152 | CA |
NPI | 1003434846 |
---|---|
Provider Name | Brian Chen |
First Address | Los Angeles, CA 90029-2917 |
Second Address | Los Angeles, CA 90029-2917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2020 |
Last Update Date | 08/07/2020 |