Provider Demographics
NPI:1013304799
Name:CHIA, TOM H (LAC)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:H
Last Name:CHIA
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 1:18595 MORONGO ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6220
Mailing Address - Country:US
Mailing Address - Phone:714-585-5802
Mailing Address - Fax:
Practice Address - Street 1:18595 MORONGO ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6220
Practice Address - Country:US
Practice Address - Phone:714-585-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16475171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist