Provider Demographics
NPI:1609287218
Name:CHUNG, EUI YOUNG (LAC)
Entity Type:Individual
Prefix:
First Name:EUI YOUNG
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:JUSTIN
Other - Middle Name:
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:950 MAGNOLIA AVE
Mailing Address - Street 2:APT 31
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-5701
Mailing Address - Country:US
Mailing Address - Phone:323-422-4964
Mailing Address - Fax:877-366-7722
Practice Address - Street 1:3407 W 6TH ST
Practice Address - Street 2:STE #702
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2537
Practice Address - Country:US
Practice Address - Phone:323-422-4964
Practice Address - Fax:877-366-7722
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16103171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist