Healthcare Provider Details

I. General information

NPI: 1962662288
Provider Name (Legal Business Name): JENG KUAN L.AC., D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 EDGEWOOD RD
MATAWAN NJ
07747-3726
US

IV. Provider business mailing address

11 EDGEWOOD RD
MATAWAN NJ
07747-3726
US

V. Phone/Fax

Practice location:
  • Phone: 626-862-7788
  • Fax:
Mailing address:
  • Phone: 626-862-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10988
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00066200
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00676900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: