Provider Demographics
NPI:1710238894
Name:CHUNG ACUPUNCTURE & HERB CLINIC INC
Entity Type:Organization
Organization Name:CHUNG ACUPUNCTURE & HERB CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KWON
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:562-944-0099
Mailing Address - Street 1:14241 IMPERIAL HWY
Mailing Address - Street 2:STE J
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1952
Mailing Address - Country:US
Mailing Address - Phone:562-944-0099
Mailing Address - Fax:562-944-4567
Practice Address - Street 1:14241 IMPERIAL HWY
Practice Address - Street 2:STE J
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1950
Practice Address - Country:US
Practice Address - Phone:562-944-0099
Practice Address - Fax:562-944-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13552171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty