Provider Demographics
NPI:1336574268
Name:CHUNG, CHONG HO (L AC)
Entity Type:Individual
Prefix:
First Name:CHONG HO
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15707 IMPERIAL HWY STE F
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2511
Mailing Address - Country:US
Mailing Address - Phone:562-943-3188
Mailing Address - Fax:562-943-3188
Practice Address - Street 1:15707 IMPERIAL HWY STE F
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-2511
Practice Address - Country:US
Practice Address - Phone:562-943-3188
Practice Address - Fax:562-943-3188
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2014-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15505171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist