Provider Demographics
NPI:1588812739
Name:CHUN, CHONG KU (LAC ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:CHONG
Middle Name:KU
Last Name:CHUN
Suffix:
Gender:F
Credentials:LAC ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21710 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2903
Mailing Address - Country:US
Mailing Address - Phone:213-864-1430
Mailing Address - Fax:
Practice Address - Street 1:8741 VAN NUYS BLVD STE 101-102
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-2440
Practice Address - Country:US
Practice Address - Phone:818-810-6888
Practice Address - Fax:818-810-0888
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12348171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 12348OtherSTATE LICENSE