Healthcare Provider Details

I. General information

NPI: 1831635135
Provider Name (Legal Business Name): CHONG ACUPUNCTURE AND INTEGRATIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 2ND ST
ENCINITAS CA
92024-5009
US

IV. Provider business mailing address

7770 REGENTS RD S.113-310
SAN DIEGO CA
92122-2421
US

V. Phone/Fax

Practice location:
  • Phone: 760-307-8801
  • Fax:
Mailing address:
  • Phone: 760-642-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16983
License Number StateCA

VIII. Authorized Official

Name: SIATNEE CHONG
Title or Position: OWNER
Credential: LAC
Phone: 619-723-5566