Provider Demographics
NPI:1770770166
Name:CHUNG, DAVID B (LAC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:CHUNG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 S VERMONT AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-4723
Mailing Address - Country:US
Mailing Address - Phone:213-384-7582
Mailing Address - Fax:
Practice Address - Street 1:698 S VERMONT AVE STE 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-4723
Practice Address - Country:US
Practice Address - Phone:213-384-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9308171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist