Provider Demographics
NPI:1184043655
Name:CHONG, KIAT FAH (LAC)
Entity Type:Individual
Prefix:
First Name:KIAT FAH
Middle Name:
Last Name:CHONG
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 1:5909 WEST LOOP S
Mailing Address - Street 2:350
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2402
Mailing Address - Country:US
Mailing Address - Phone:281-845-9832
Mailing Address - Fax:
Practice Address - Street 1:4611 VERONE ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-5515
Practice Address - Country:US
Practice Address - Phone:281-891-3857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01389171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist