Provider Demographics
NPI:1568817252
Name:CHONG, SIATNEE (LAC)
Entity Type:Individual
Prefix:
First Name:SIATNEE
Middle Name:
Last Name:CHONG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SIDNEE
Other - Middle Name:
Other - Last Name:CHONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:7770 REGENTS RD # 113-310
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1937
Mailing Address - Country:US
Mailing Address - Phone:619-723-5566
Mailing Address - Fax:
Practice Address - Street 1:1054 2ND ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5009
Practice Address - Country:US
Practice Address - Phone:760-307-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16983171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist