Provider Demographics
NPI:1831635135
Name:CHONG ACUPUNCTURE AND INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:CHONG ACUPUNCTURE AND INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIATNEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHONG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:619-723-5566
Mailing Address - Street 1:7770 REGENTS RD S.113-310
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2421
Mailing Address - Country:US
Mailing Address - Phone:760-642-2100
Mailing Address - Fax:
Practice Address - Street 1:1054 2ND ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5009
Practice Address - Country:US
Practice Address - Phone:760-307-8801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16983171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty