Healthcare Provider Details

I. General information

NPI: 1144984048
Provider Name (Legal Business Name): HONG TACK CHUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/17/2023
Certification Date: 06/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 WILSHIRE BLVD STE 100
LOS ANGELES CA
90010-1405
US

IV. Provider business mailing address

3727 W 6TH ST STE 210
LOS ANGELES CA
90020-5108
US

V. Phone/Fax

Practice location:
  • Phone: 213-235-2500
  • Fax:
Mailing address:
  • Phone: 213-235-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: