Provider Demographics
NPI:1053141747
Name:CHING, ROWAN (LAC)
Entity type:Individual
Prefix:
First Name:ROWAN
Middle Name:
Last Name:CHING
Suffix:
Gender:X
Credentials:LAC
Other - Prefix:
Other - First Name:KEILA
Other - Middle Name:KAHIKINAOKALA
Other - Last Name:CHING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4939 HAZEL AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-2297
Mailing Address - Country:US
Mailing Address - Phone:808-729-4750
Mailing Address - Fax:
Practice Address - Street 1:707 S 50TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1658
Practice Address - Country:US
Practice Address - Phone:808-729-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001434171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist