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General NPI Number Information
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NPI Number | 1710238894
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Entity Type | Organization
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Legal Business Name | CHUNG ACUPUNCTURE & HERB CLINIC INC
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 14241 IMPERIAL HWY STE J
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City | LA MIRADA
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State | CA
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Zip | 90638-1950
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Country | US
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Telephone | 562-944-0099
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Fax | 562-944-4567
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Provider Business Mailing Address
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Address Line | 14241 IMPERIAL HWY STE J
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City | LA MIRADA
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State | CA
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Zip | 90638-1952
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Country | US
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Telephone | 562-944-0099
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Fax | 562-944-4567
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Authorized Official
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Title or Position | CEO
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Name | KWON YOUNG CHUNG
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Credential | L.AC.
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Telephone | 562-944-0099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC13552
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License Number State | CA
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