Healthcare Provider Details

I. General information

NPI: 1144355561
Provider Name (Legal Business Name): SARA P CHUNG LICENSED ACUPUNCTURI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 EL CAMINO REAL #403
MILLBRAE CA
94030
US

IV. Provider business mailing address

475 EL CAMINO REAL #403
MILLBRAE CA
94030
US

V. Phone/Fax

Practice location:
  • Phone: 650-697-4211
  • Fax:
Mailing address:
  • Phone: 650-697-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC2176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: