Provider Demographics
NPI:1467647495
Name:CHUNG, HYERYUN ESTHER (LAC)
Entity Type:Individual
Prefix:
First Name:HYERYUN
Middle Name:ESTHER
Last Name:CHUNG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-5672
Mailing Address - Country:US
Mailing Address - Phone:770-875-9555
Mailing Address - Fax:770-962-5335
Practice Address - Street 1:303 SCENIC HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-5672
Practice Address - Country:US
Practice Address - Phone:770-875-9555
Practice Address - Fax:770-814-9277
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000136171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist