Provider Demographics
NPI:1093959769
Name:HUR, CHAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:CHAN
Middle Name:
Last Name:HUR
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6927 JUNO ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5837
Mailing Address - Country:US
Mailing Address - Phone:718-228-1972
Mailing Address - Fax:
Practice Address - Street 1:6927 JUNO ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5837
Practice Address - Country:US
Practice Address - Phone:718-228-1972
Practice Address - Fax:718-544-7716
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-26
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003877-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist