Provider Demographics
NPI:1962662288
Name:KUAN, JENG (LAC, DC)
Entity Type:Individual
Prefix:DR
First Name:JENG
Middle Name:
Last Name:KUAN
Suffix:
Gender:M
Credentials:LAC, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3726
Mailing Address - Country:US
Mailing Address - Phone:626-862-7788
Mailing Address - Fax:
Practice Address - Street 1:11 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3726
Practice Address - Country:US
Practice Address - Phone:626-862-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10988171100000X
NJ25MZ00066200171100000X
NJ38MC00676900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist