Healthcare Provider Details

I. General information

NPI: 1013246263
Provider Name (Legal Business Name): CHUNG-PO PETER WANG D.C., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9939 GARVEY AVE STE A
EL MONTE CA
91733-4712
US

IV. Provider business mailing address

9939 GARVEY AVE STE A
EL MONTE CA
91733-4712
US

V. Phone/Fax

Practice location:
  • Phone: 626-442-0800
  • Fax: 626-442-3800
Mailing address:
  • Phone: 626-442-0800
  • Fax: 626-442-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 31223
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 13178
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: