Provider Demographics
NPI:1295208700
Name:HUNG, NELSON REX (LAC)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:REX
Last Name:HUNG
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 1:2131 CENTURY PARK LN APT 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-3312
Mailing Address - Country:US
Mailing Address - Phone:310-926-9878
Mailing Address - Fax:
Practice Address - Street 1:13101 W WASHINGTON BLVD STE 209
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5173
Practice Address - Country:US
Practice Address - Phone:310-916-9878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18360171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist