Provider Demographics
NPI:1982887360
Name:GANG, CHIN (L AC)
Entity Type:Individual
Prefix:
First Name:CHIN
Middle Name:
Last Name:GANG
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3220 CASTERA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1608
Mailing Address - Country:US
Mailing Address - Phone:818-640-2236
Mailing Address - Fax:818-541-1040
Practice Address - Street 1:6237 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2723
Practice Address - Country:US
Practice Address - Phone:818-541-1040
Practice Address - Fax:818-541-1040
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-09
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11560171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist