Provider Demographics
NPI:1881868636
Name:CHUNG, TIMOTHY (LAC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 90TH ST APT 5E
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-8712
Mailing Address - Country:US
Mailing Address - Phone:310-990-2331
Mailing Address - Fax:
Practice Address - Street 1:2 E 76TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2611
Practice Address - Country:US
Practice Address - Phone:310-990-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003384-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist