Provider Demographics
NPI:1487611067
Name:CHUNG, JIM Y (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:JIM
Middle Name:Y
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:DR
Other - First Name:JIM
Other - Middle Name:YUNG-CHUN
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, LAC
Mailing Address - Street 1:14785 JEFFREY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-0408
Mailing Address - Country:US
Mailing Address - Phone:949-857-2388
Mailing Address - Fax:949-857-0198
Practice Address - Street 1:14785 JEFFREY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0408
Practice Address - Country:US
Practice Address - Phone:949-857-2388
Practice Address - Fax:949-857-0198
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29229111NS0005X
NVB02002111NS0005X
CAAC11395171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV09342Medicare UPIN
CADC29229Medicare ID - Type Unspecified