Provider Demographics
NPI:1679784219
Name:HO, TZUEN JEN (DC)
Entity type:Individual
Prefix:DR
First Name:TZUEN JEN
Middle Name:
Last Name:HO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:CLEMENT
Other - Middle Name:TJ
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:900 S SAN GABRIEL BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-2762
Mailing Address - Country:US
Mailing Address - Phone:626-285-9819
Mailing Address - Fax:626-285-9838
Practice Address - Street 1:900 S SAN GABRIEL BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-2762
Practice Address - Country:US
Practice Address - Phone:626-285-9819
Practice Address - Fax:626-285-9838
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC21874AOtherMEDICARE PROVIDER NUMBER
CADC0218740OtherBLUE SHIELD PROVIDER NUM.
CAU56285Medicare UPIN
CAWDC21874AOtherMEDICARE PROVIDER NUMBER