Provider Demographics
NPI:1740377738
Name:CHUNG, JANE K (LAC)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:K
Last Name:CHUNG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:21301 NORWALK BLVD. UNIT 96
Mailing Address - Street 2:
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716
Mailing Address - Country:US
Mailing Address - Phone:714-293-5544
Mailing Address - Fax:562-278-2378
Practice Address - Street 1:13341 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2255
Practice Address - Country:US
Practice Address - Phone:714-293-5544
Practice Address - Fax:562-278-2378
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5795171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7817487OtherAETNA
CACA0057950OtherBLUE SHIELD OF CALIFORNIA