Provider Demographics
NPI:1366721912
Name:GIDDING, CHUNGLING WANG
Entity type:Individual
Prefix:DR
First Name:CHUNGLING
Middle Name:WANG
Last Name:GIDDING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 BROADWAY APT 102
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2862
Mailing Address - Country:US
Mailing Address - Phone:310-922-0965
Mailing Address - Fax:
Practice Address - Street 1:1912 BROADWAY APT 102
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2862
Practice Address - Country:US
Practice Address - Phone:310-922-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7585171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist