Provider Demographics
NPI:1598967507
Name:NG, CHUN JACKSON (DC, PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHUN
Middle Name:JACKSON
Last Name:NG
Suffix:
Gender:M
Credentials:DC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3927
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92834-3927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18575 GALE AVE
Practice Address - Street 2:SUITE 278
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1340
Practice Address - Country:US
Practice Address - Phone:888-997-2674
Practice Address - Fax:714-798-2366
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29413111NS0005X
CAPA 21272363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111NS0005XChiropractic ProvidersChiropractorSports Physician