Provider Demographics
NPI:1285073429
Name:TA, CHUONG HOANG (DAOM, LAC,)
Entity type:Individual
Prefix:MR
First Name:CHUONG
Middle Name:HOANG
Last Name:TA
Suffix:
Gender:M
Credentials:DAOM, LAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14260 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683
Mailing Address - Country:US
Mailing Address - Phone:657-400-9163
Mailing Address - Fax:424-232-8101
Practice Address - Street 1:14260 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:657-400-9163
Practice Address - Fax:424-232-8101
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15340171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist