Provider Demographics
NPI:1033248398
Name:CHUNG, HYUN MO (LAC)
Entity Type:Individual
Prefix:
First Name:HYUN
Middle Name:MO
Last Name:CHUNG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4725 1ST ST STE 270
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7136
Mailing Address - Country:US
Mailing Address - Phone:925-249-9642
Mailing Address - Fax:925-249-9643
Practice Address - Street 1:4725 1ST ST STE 270
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7136
Practice Address - Country:US
Practice Address - Phone:925-249-9642
Practice Address - Fax:925-249-9643
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC007067171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist