Provider Demographics
NPI:1063968568
Name:HAN, KYU CHONG (LAC)
Entity type:Individual
Prefix:MR
First Name:KYU
Middle Name:CHONG
Last Name:HAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:2505 SAMARITAN DR
Mailing Address - Street 2:UNIT 305
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4006
Mailing Address - Country:US
Mailing Address - Phone:408-560-9470
Mailing Address - Fax:408-560-9278
Practice Address - Street 1:2505 SAMARITAN DR
Practice Address - Street 2:UNIT 305
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4006
Practice Address - Country:US
Practice Address - Phone:408-560-9470
Practice Address - Fax:408-560-9278
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA16494171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist