Provider Demographics
NPI:1588417497
Name:GAM, CHEOLOU (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:CHEOLOU
Middle Name:
Last Name:GAM
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 MAC ARTHUR DR # 106
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-4450
Mailing Address - Country:US
Mailing Address - Phone:469-873-3745
Mailing Address - Fax:
Practice Address - Street 1:1028 MAC ARTHUR DR # 106
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-4450
Practice Address - Country:US
Practice Address - Phone:469-873-3745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC02161171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist