Provider Demographics
NPI:1154583037
Name:CHUNG, JAY JINHAN (LAC)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:JINHAN
Last Name:CHUNG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:5072 APPLE TREE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2302
Mailing Address - Country:US
Mailing Address - Phone:949-554-4285
Mailing Address - Fax:
Practice Address - Street 1:1617 WESTCLIFF DR STE 205
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5526
Practice Address - Country:US
Practice Address - Phone:949-650-0736
Practice Address - Fax:949-650-3912
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7172171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist