Provider Demographics
NPI:1447379086
Name:PONG, LICHUNG TERESA (LAC, PHD)
Entity Type:Individual
Prefix:DR
First Name:LICHUNG
Middle Name:TERESA
Last Name:PONG
Suffix:
Gender:F
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 SWIFT BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3521
Mailing Address - Country:US
Mailing Address - Phone:509-943-1015
Mailing Address - Fax:509-943-1023
Practice Address - Street 1:750 SWIFT BLVD STE 10
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3521
Practice Address - Country:US
Practice Address - Phone:509-943-1015
Practice Address - Fax:509-943-1023
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002971171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist