Provider Demographics
NPI:1366809337
Name:CHUNG, HSIANG JU (LAC)
Entity type:Individual
Prefix:MISS
First Name:HSIANG
Middle Name:JU
Last Name:CHUNG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:7660 KILARNEY LN
Mailing Address - Street 2:APT 147
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-2982
Mailing Address - Country:US
Mailing Address - Phone:626-551-7976
Mailing Address - Fax:
Practice Address - Street 1:7660 KILARNEY LN
Practice Address - Street 2:APT 147
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-2982
Practice Address - Country:US
Practice Address - Phone:626-551-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 16881171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist