Healthcare Provider Details

I. General information

NPI: 1396192910
Provider Name (Legal Business Name): HUNG CHENG KUO LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3862 SMITH ST
UNION CITY CA
94587-2614
US

IV. Provider business mailing address

2619 COPA DEL ORO DR
UNION CITY CA
94587-3175
US

V. Phone/Fax

Practice location:
  • Phone: 510-219-3806
  • Fax:
Mailing address:
  • Phone: 510-219-3806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: