Provider Demographics
NPI:1033457171
Name:DR. CHUNG ACUPUNCTURE CLINIC, INC.
Entity Type:Organization
Organization Name:DR. CHUNG ACUPUNCTURE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HYUN
Authorized Official - Middle Name:SOO
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM,LAC
Authorized Official - Phone:818-517-6940
Mailing Address - Street 1:4711 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1636
Mailing Address - Country:US
Mailing Address - Phone:818-517-6940
Mailing Address - Fax:818-937-9335
Practice Address - Street 1:801 S CHEVY CHASE DR
Practice Address - Street 2:#104
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4431
Practice Address - Country:US
Practice Address - Phone:818-517-6940
Practice Address - Fax:818-937-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12319171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty