Provider Demographics
NPI:1194756551
Name:KWANG, CHARLES JUNG CHAO (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JUNG CHAO
Last Name:KWANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 883
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-0883
Mailing Address - Country:US
Mailing Address - Phone:626-786-7704
Mailing Address - Fax:626-810-0113
Practice Address - Street 1:65 N 1ST AVE
Practice Address - Street 2:204
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3207
Practice Address - Country:US
Practice Address - Phone:626-786-7704
Practice Address - Fax:626-810-0113
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0281110OtherMEDICAL NUMBER
CADC0281110OtherBLUESHIELD NUMBER
CADC28111OtherPPO NUMBER