Provider Demographics
NPI:1215291646
Name:CHUN, ANTHONY (LACLMT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:CHUN
Suffix:
Gender:M
Credentials:LACLMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13913 87TH RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3011
Mailing Address - Country:US
Mailing Address - Phone:718-813-6815
Mailing Address - Fax:
Practice Address - Street 1:13913 87TH RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3011
Practice Address - Country:US
Practice Address - Phone:718-813-6815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003554171100000X
NY013576225700000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist