Provider Demographics
NPI:1689794844
Name:CHUNG, HSIAO-LAN (OMD)
Entity Type:Individual
Prefix:
First Name:HSIAO-LAN
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 WHITLEY RD
Mailing Address - Street 2:STE A
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2483
Mailing Address - Country:US
Mailing Address - Phone:817-583-8808
Mailing Address - Fax:817-583-8808
Practice Address - Street 1:8305 WHITLEY RD
Practice Address - Street 2:STE A
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2483
Practice Address - Country:US
Practice Address - Phone:817-583-8808
Practice Address - Fax:817-583-8808
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00957171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M8488OtherBCBS OF TX
TX11789775OtherCAQH