Provider Demographics
NPI:1992115612
Name:CHI, JUNG-YUAN (LAC)
Entity type:Individual
Prefix:
First Name:JUNG-YUAN
Middle Name:
Last Name:CHI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10414 VACCO ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-3350
Mailing Address - Country:US
Mailing Address - Phone:626-636-8706
Mailing Address - Fax:
Practice Address - Street 1:10408 VACCO ST UNIT B
Practice Address - Street 2:
Practice Address - City:SOUTH EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-3328
Practice Address - Country:US
Practice Address - Phone:626-636-8706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5364171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist