MEDICARE: CHONG OK JUN LA.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	U01229	MD

General Provider Information

NPI Number	:	1710187075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHONG OK JUN LA.C

Provider Business Mailing Address
First Line	:	9050 FREDERICK RD STE D
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-4038
Country	:	US
Telephone Number	:	410-203-1012
Fax Number	:	410-203-1013

Provider Business Practice Location Address
First Line	:	9050 FREDERICK RD STE D
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-4038
Country	:	US
Telephone Number	:	410-203-1012
Fax Number	:	410-203-1013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/24/2007

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