Provider Demographics
NPI:1477885077
Name:CHUANG, CHARLIE Y (DAOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:CHARLIE
Middle Name:Y
Last Name:CHUANG
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15596 LANYARD LN
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-8709
Mailing Address - Country:US
Mailing Address - Phone:909-693-4768
Mailing Address - Fax:
Practice Address - Street 1:15338 CENTRAL AVE # 109
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710
Practice Address - Country:US
Practice Address - Phone:909-693-4768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13164171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC13164OtherCA ACUPUNCTURE LICENSE
CAA9522014OtherCA DRIVER LICENSE