Provider Demographics
NPI:1780898387
Name:FANG, CHAOHUA (LAC)
Entity type:Individual
Prefix:
First Name:CHAOHUA
Middle Name:
Last Name:FANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 E WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2943
Mailing Address - Country:US
Mailing Address - Phone:760-256-7368
Mailing Address - Fax:760-256-7368
Practice Address - Street 1:608 E WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2943
Practice Address - Country:US
Practice Address - Phone:760-256-7368
Practice Address - Fax:760-256-7368
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4814171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist