Healthcare Provider Details

I. General information

NPI: 1679852552
Provider Name (Legal Business Name): KENNETH HUNG CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W CHAPMAN AVE STE 121
ORANGE CA
92868-2331
US

IV. Provider business mailing address

2140 W CHAPMAN AVE STE 121
ORANGE CA
92868-2331
US

V. Phone/Fax

Practice location:
  • Phone: 714-978-6784
  • Fax: 714-978-0854
Mailing address:
  • Phone: 714-978-6784
  • Fax: 714-978-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: