Healthcare Provider Details

I. General information

NPI: 1487611067
Provider Name (Legal Business Name): JIM Y. CHUNG D.C., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JIM YUNG-CHUN CHUNG D.C., L.AC.

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14785 JEFFREY RD SUITE 102
IRVINE CA
92618-0408
US

IV. Provider business mailing address

14785 JEFFREY RD SUITE 102
IRVINE CA
92618-0408
US

V. Phone/Fax

Practice location:
  • Phone: 949-857-2388
  • Fax: 949-857-0198
Mailing address:
  • Phone: 949-857-2388
  • Fax: 949-857-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC29229
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberB02002
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: