Basic Information
| Provider Information | |||||||||
| NPI: | 1225260375 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAO | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6301 BEACH BLVD | ||||||||
| Address2: | SUITE 111 & 101 | ||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906212840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147835889 | ||||||||
| FaxNumber: | 7149948090 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 MONTEREY RD | ||||||||
| Address2: | #1005 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912062052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182913958 | ||||||||
| FaxNumber: | 8185020435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2009 | ||||||||
| LastUpdateDate: | 08/21/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | AC12762 | CA | Y | Other Service Providers | Acupuncturist |
No ID Information.