Provider Demographics
NPI:1083238711
Name:CHU, KEVIN (L AC, DACM)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:CHU
Suffix:
Gender:M
Credentials:L AC, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 PFEIFER LN
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-8803
Mailing Address - Country:US
Mailing Address - Phone:619-565-9102
Mailing Address - Fax:
Practice Address - Street 1:460 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6275
Practice Address - Country:US
Practice Address - Phone:619-565-9102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18371171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist