Healthcare Provider Details

I. General information

NPI: 1902141674
Provider Name (Legal Business Name): TONG SOON CHUNG L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 W. OLYMPIC BLVD. # 201
LOS ANGELES CA
90006
US

IV. Provider business mailing address

2560 W. OLYMPIC BLVD. # 201
LOS ANGELES CA
90006
US

V. Phone/Fax

Practice location:
  • Phone: 213-383-0007
  • Fax: 877-234-2675
Mailing address:
  • Phone: 213-383-0007
  • Fax: 877-234-2675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC14751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: