Provider Demographics
NPI:1992567283
Name:CHONG, DAN CHAEKOO (LAC)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:CHAEKOO
Last Name:CHONG
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 1:2914 139TH ST APT 4E
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2040
Mailing Address - Country:US
Mailing Address - Phone:917-538-0749
Mailing Address - Fax:
Practice Address - Street 1:14370 SANFORD AVE APT 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2028
Practice Address - Country:US
Practice Address - Phone:917-538-0749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007138171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist