=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134360209
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CKC ACUPUNCTURE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2009
-----------------------------------------------------
Last Update Date | 05/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8741 VAN NUYS BLVD SUITE 102
-----------------------------------------------------
City | PANORAMA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91402-2440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-894-4785
-----------------------------------------------------
Fax | 818-894-6061
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8741 VAN NUYS BLVD SUITE 102
-----------------------------------------------------
City | PANORAMA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91402-2440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-894-4785
-----------------------------------------------------
Fax | 818-894-6061
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MISS CHONG KU CHUN
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 818-894-4785
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC12009
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------