Provider Demographics
NPI:1912418492
Name:HSIAO, CHUNMING (LAC)
Entity Type:Individual
Prefix:
First Name:CHUNMING
Middle Name:
Last Name:HSIAO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:BRUCE
Other - Middle Name:C
Other - Last Name:HSIAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 LEAGUE UNIT 61562
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-7072
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22706 ASPAN ST STE 300
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1603
Practice Address - Country:US
Practice Address - Phone:949-472-6391
Practice Address - Fax:949-472-6414
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2018-09-26
Deactivation Date:2018-01-23
Deactivation Code:
Reactivation Date:2018-09-25
Provider Licenses
StateLicense IDTaxonomies
CAAC17765171100000X
CA33154225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty