TIEN CHUNG GU DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****26

License Status

CANCELLED

Business

First Name

TIEN

Middle

CHUNG

Last Name

Suffix

Business Name

TIEN CHUNG GU DO

Original Issue Date

06/25/2002

Effective Date

06/25/2002

Expiration Date

07/31/2005

City

DIXON

State

Zip

61021

County

LEE

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

10/09/2006