Provider Demographics
NPI:1013646041
Name:WON, SUMI
Entity Type:Individual
Prefix:
First Name:SUMI
Middle Name:
Last Name:WON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12721 NEWPORT AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-8031
Mailing Address - Country:US
Mailing Address - Phone:949-527-8348
Mailing Address - Fax:
Practice Address - Street 1:12721 NEWPORT AVE STE 2
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-8031
Practice Address - Country:US
Practice Address - Phone:949-527-8348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19010171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist