Provider Demographics
NPI:1225260375
Name:CHAO, KENNETH (LAC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:CHAO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6301 BEACH BLVD
Mailing Address - Street 2:SUITE 111 & 101
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2840
Mailing Address - Country:US
Mailing Address - Phone:714-783-5889
Mailing Address - Fax:714-994-8090
Practice Address - Street 1:222 MONTEREY RD
Practice Address - Street 2:#1005
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-2052
Practice Address - Country:US
Practice Address - Phone:818-291-3958
Practice Address - Fax:818-502-0435
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC12762171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist