Provider Demographics
NPI:1134360209
Name:CKC ACUPUNCTURE, INC
Entity type:Organization
Organization Name:CKC ACUPUNCTURE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHONG
Authorized Official - Middle Name:KU
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:818-894-4785
Mailing Address - Street 1:8741 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-2440
Mailing Address - Country:US
Mailing Address - Phone:818-894-4785
Mailing Address - Fax:818-894-6061
Practice Address - Street 1:8741 VAN NUYS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-2440
Practice Address - Country:US
Practice Address - Phone:818-894-4785
Practice Address - Fax:818-894-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12009171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC12348OtherSTATE LICENSE