MEDICARE: MR. WONCHOL CHONG A.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC5828	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003976721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WONCHOL CHONG A.C.

Provider Business Mailing Address
First Line	:	869 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1522
Country	:	US
Telephone Number	:	213-487-4090
Fax Number	:	213-487-4464

Provider Business Practice Location Address
First Line	:	869 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1522
Country	:	US
Telephone Number	:	213-487-4090
Fax Number	:	213-487-4464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/09/2007

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