Provider Demographics
NPI:1285755850
Name:MODESTO ACUPUNCTURE
Entity type:Organization
Organization Name:MODESTO ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURIST
Authorized Official - Phone:209-524-6154
Mailing Address - Street 1:2020 COFFEE ROAD
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2407
Mailing Address - Country:US
Mailing Address - Phone:209-524-6154
Mailing Address - Fax:209-491-2787
Practice Address - Street 1:2020 COFFEE ROAD
Practice Address - Street 2:SUITE B-5
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2407
Practice Address - Country:US
Practice Address - Phone:209-524-6154
Practice Address - Fax:209-491-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10857171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty