Provider Demographics
NPI:1417126673
Name:CHUNG, JAY (LAC)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:16 ALBERTSON PKWY
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1202
Mailing Address - Country:US
Mailing Address - Phone:516-626-2093
Mailing Address - Fax:516-626-2679
Practice Address - Street 1:16 ALBERTSON PKWY
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1202
Practice Address - Country:US
Practice Address - Phone:516-578-8335
Practice Address - Fax:516-626-2093
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003553171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003553OtherLAC LICENSE NUMBER