Provider Demographics
NPI:1245353671
Name:LEE, CHUAN TUNG (LAC)
Entity type:Individual
Prefix:
First Name:CHUAN TUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:CHUAN TUNG
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:2844 SUMMIT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3642
Mailing Address - Country:US
Mailing Address - Phone:510-451-4563
Mailing Address - Fax:510-451-4863
Practice Address - Street 1:2844 SUMMIT ST STE 200
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3642
Practice Address - Country:US
Practice Address - Phone:510-451-4563
Practice Address - Fax:510-451-4863
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10781171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 10781OtherLICENSED ACUPUNCTURIST