Provider Demographics
NPI:1548698707
Name:CHUONG, STANLY (LAC)
Entity type:Individual
Prefix:MR
First Name:STANLY
Middle Name:
Last Name:CHUONG
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 1:2020 COFFEE RD., STE. B5
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355
Mailing Address - Country:US
Mailing Address - Phone:209-464-4192
Mailing Address - Fax:209-464-0288
Practice Address - Street 1:2020 COFFEE RD., STE. B5
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-464-2095
Practice Address - Fax:209-491-2000
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-28
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10857171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist