Provider Demographics
NPI:1073953121
Name:HSU, CHING KUNG (LAC)
Entity Type:Individual
Prefix:MR
First Name:CHING KUNG
Middle Name:
Last Name:HSU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:ANDREW C.
Other - Middle Name:
Other - Last Name:HSU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:416 W LAS TUNAS DR
Mailing Address - Street 2:STE#305
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1236
Mailing Address - Country:US
Mailing Address - Phone:626-512-1505
Mailing Address - Fax:
Practice Address - Street 1:4469 REDONDO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3465
Practice Address - Country:US
Practice Address - Phone:626-512-1505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14780171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist