Provider Demographics
NPI:1497084024
Name:CHEN, CHENG-JUNG (LAC)
Entity Type:Individual
Prefix:MISS
First Name:CHENG-JUNG
Middle Name:
Last Name:CHEN
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 1:22706 ASPAN ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1603
Mailing Address - Country:US
Mailing Address - Phone:949-454-2820
Mailing Address - Fax:
Practice Address - Street 1:22706 ASPAN ST
Practice Address - Street 2:SUITE 504
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1603
Practice Address - Country:US
Practice Address - Phone:949-454-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13337171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist