MEDICARE: DR. CHI NAM PHUNG

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	AC0029360	CA

General Provider Information

NPI Number	:	1518057561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHI NAM PHUNG

Provider Business Mailing Address
First Line	:	2209 SAN GABRIEL BLVD
Second Line	:	SUITE B
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-3664
Country	:	US
Telephone Number	:	626-288-1525
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 SAN GABRIEL BLVD
Second Line	:	SUITE B
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-3664
Country	:	US
Telephone Number	:	626-274-6326
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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