Provider Demographics
NPI:1679736698
Name:JUN, CHUNG LAI (MASTER DEGREE)
Entity type:Individual
Prefix:MRS
First Name:CHUNG
Middle Name:LAI
Last Name:JUN
Suffix:
Gender:F
Credentials:MASTER DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1145 E CLARK AV
Mailing Address - Street 2:#D
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455
Mailing Address - Country:US
Mailing Address - Phone:805-938-5577
Mailing Address - Fax:805-938-5667
Practice Address - Street 1:1145 E CLARK AV
Practice Address - Street 2:#D
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455
Practice Address - Country:US
Practice Address - Phone:805-938-5577
Practice Address - Fax:805-938-5667
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7248171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist