Provider Demographics
NPI:1437433315
Name:CHUANG, TSONG JUN (ODM)
Entity Type:Individual
Prefix:MR
First Name:TSONG
Middle Name:JUN
Last Name:CHUANG
Suffix:
Gender:M
Credentials:ODM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21849 ARBOR CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1490
Mailing Address - Country:US
Mailing Address - Phone:909-569-4263
Mailing Address - Fax:
Practice Address - Street 1:21849 ARBOR CT
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1490
Practice Address - Country:US
Practice Address - Phone:909-706-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14458171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist