Provider Demographics
NPI:1427298769
Name:KUNG, TERESA ATANANTE (LAC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ATANANTE
Last Name:KUNG
Suffix:
Gender:F
Credentials:LAC
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 35
Mailing Address - Street 2:
Mailing Address - City:SAN GREGORIO
Mailing Address - State:CA
Mailing Address - Zip Code:94074-0035
Mailing Address - Country:US
Mailing Address - Phone:650-391-7281
Mailing Address - Fax:
Practice Address - Street 1:799 MAIN ST
Practice Address - Street 2:SUITE A , B
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1996
Practice Address - Country:US
Practice Address - Phone:650-391-7281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11714171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist