Provider Demographics
NPI:1396192910
Name:KUO, HUNG CHENG (LAC)
Entity Type:Individual
Prefix:
First Name:HUNG
Middle Name:CHENG
Last Name:KUO
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 1:2619 COPA DEL ORO DR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3175
Mailing Address - Country:US
Mailing Address - Phone:510-219-3806
Mailing Address - Fax:
Practice Address - Street 1:3862 SMITH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-2614
Practice Address - Country:US
Practice Address - Phone:510-219-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17054171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist