Provider Demographics
NPI:1417198250
Name:SUNG, CHUNG HAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:CHUNG
Middle Name:HAN
Last Name:SUNG
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 1:1025 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-1617
Mailing Address - Country:US
Mailing Address - Phone:626-813-1957
Mailing Address - Fax:626-813-1472
Practice Address - Street 1:1025 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746-1617
Practice Address - Country:US
Practice Address - Phone:626-813-1957
Practice Address - Fax:626-813-1472
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5284171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171100000XOtherACUPUNCTURE