Provider Demographics
NPI:1336705680
Name:CHUNG, TONY (DACM)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16226 POCONO ST
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-3245
Mailing Address - Country:US
Mailing Address - Phone:626-330-6826
Mailing Address - Fax:
Practice Address - Street 1:20272 CARREY RD
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2302
Practice Address - Country:US
Practice Address - Phone:626-474-3864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18523171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist