Provider Demographics
NPI:1356641963
Name:KUNG, ANGELA C (LAC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:KUNG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27405 PUERTA REAL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6314
Mailing Address - Country:US
Mailing Address - Phone:714-403-3291
Mailing Address - Fax:
Practice Address - Street 1:27405 PUERTA REAL
Practice Address - Street 2:SUITE 210
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6314
Practice Address - Country:US
Practice Address - Phone:714-403-3291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13865171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist