Provider Demographics
NPI:1871178400
Name:YOO, CHANG BUM (LAC)
Entity type:Individual
Prefix:
First Name:CHANG BUM
Middle Name:
Last Name:YOO
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 1:3060 W OLYMPIC BLVD # 120
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3832
Mailing Address - Country:US
Mailing Address - Phone:213-505-4740
Mailing Address - Fax:
Practice Address - Street 1:3060 W OLYMPIC BLVD # 120
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-3832
Practice Address - Country:US
Practice Address - Phone:213-505-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12328171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist