Provider Demographics
NPI:1407973506
Name:CHERNG, KENNY GUANYIING (LAC)
Entity Type:Individual
Prefix:MR
First Name:KENNY
Middle Name:GUANYIING
Last Name:CHERNG
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 1:12979 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4122
Mailing Address - Country:US
Mailing Address - Phone:909-628-1955
Mailing Address - Fax:909-628-1085
Practice Address - Street 1:620 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8059
Practice Address - Country:US
Practice Address - Phone:909-792-4434
Practice Address - Fax:909-628-1085
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4514171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC4514OtherACUPUNCTUR LICENSE NUMBER