Provider Demographics
NPI:1568843902
Name:CHUNG, SAMUEL
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6514 LONETREE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-6005
Mailing Address - Country:US
Mailing Address - Phone:916-581-6236
Mailing Address - Fax:916-352-6521
Practice Address - Street 1:6514 LONETREE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-6005
Practice Address - Country:US
Practice Address - Phone:916-581-6236
Practice Address - Fax:916-352-6521
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13981171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist