Provider Demographics
NPI:1447519475
Name:CHOI, JUNGSOOK (LAC)
Entity type:Individual
Prefix:
First Name:JUNGSOOK
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S WESTMORELAND AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1574
Mailing Address - Country:US
Mailing Address - Phone:213-700-9285
Mailing Address - Fax:
Practice Address - Street 1:8215 VAN NUYS BLVD STE 306
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4839
Practice Address - Country:US
Practice Address - Phone:818-376-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11712171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist