Provider Demographics
NPI:1821407370
Name:CHUANG, JENNIFER (L AC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CHUANG
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6948 FERNCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-1002
Mailing Address - Country:US
Mailing Address - Phone:626-272-1289
Mailing Address - Fax:
Practice Address - Street 1:6948 FERNCROFT AVE
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91775-1002
Practice Address - Country:US
Practice Address - Phone:626-272-1289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15476171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist