Provider Demographics
NPI:1043513559
Name:JUNG, JI HWAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:JI HWAN
Middle Name:
Last Name:JUNG
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 1:903 CRENSHAW BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1965
Mailing Address - Country:US
Mailing Address - Phone:213-999-3469
Mailing Address - Fax:
Practice Address - Street 1:903 CRENSHAW BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1965
Practice Address - Country:US
Practice Address - Phone:213-999-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14041171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist