Provider Demographics
NPI:1164711891
Name:CHUNG, CONNIE YEONHEE (DC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:YEONHEE
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3148 EL CAMINO REAL STE 107
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-2930
Mailing Address - Country:US
Mailing Address - Phone:408-296-5959
Mailing Address - Fax:408-261-0462
Practice Address - Street 1:3148 EL CAMINO REAL STE 107
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-2930
Practice Address - Country:US
Practice Address - Phone:408-296-5959
Practice Address - Fax:408-261-0462
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor