Provider Demographics
NPI:1467677765
Name:CHUNG, JONG MOON IX (DC LAC)
Entity Type:Individual
Prefix:DR
First Name:JONG
Middle Name:MOON
Last Name:CHUNG
Suffix:IX
Gender:M
Credentials:DC LAC
Other - Prefix:DR
Other - First Name:JONG
Other - Middle Name:MOON
Other - Last Name:CHUNG
Other - Suffix:IX
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3251 W 6TH ST
Mailing Address - Street 2:107
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-5023
Mailing Address - Country:US
Mailing Address - Phone:213-637-0171
Mailing Address - Fax:213-637-0174
Practice Address - Street 1:3251 W 6TH ST
Practice Address - Street 2:107
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-5023
Practice Address - Country:US
Practice Address - Phone:213-637-0171
Practice Address - Fax:213-637-0174
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD.C 29799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor