Provider Demographics
NPI:1659483386
Name:CHUNG, FANGLI (LAC)
Entity Type:Individual
Prefix:MS
First Name:FANGLI
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 E CHAPMAN AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4141
Mailing Address - Country:US
Mailing Address - Phone:714-871-3660
Mailing Address - Fax:714-871-3661
Practice Address - Street 1:1950 E CHAPMAN AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4141
Practice Address - Country:US
Practice Address - Phone:714-871-3660
Practice Address - Fax:714-871-3661
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#7988171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist