Provider Demographics
NPI:1871175489
Name:KWEN, CHEUL H (LAC)
Entity type:Individual
Prefix:
First Name:CHEUL
Middle Name:H
Last Name:KWEN
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 1:122 S ST ANDREWS PL APT 229
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5033
Mailing Address - Country:US
Mailing Address - Phone:213-840-5591
Mailing Address - Fax:
Practice Address - Street 1:2897 W OLYMPIC BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2639
Practice Address - Country:US
Practice Address - Phone:800-385-1130
Practice Address - Fax:213-386-7583
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18214171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty