Provider Demographics
NPI:1255193975
Name:KUNG, FAN CHI (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:FAN CHI
Middle Name:
Last Name:KUNG
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 IVORY DR
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-3232
Mailing Address - Country:US
Mailing Address - Phone:626-371-3303
Mailing Address - Fax:
Practice Address - Street 1:2065 IVORY DR
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3232
Practice Address - Country:US
Practice Address - Phone:626-371-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19927171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist