Provider Demographics
NPI:1053508119
Name:KO, BUM JUNG
Entity Type:Individual
Prefix:
First Name:BUM JUNG
Middle Name:
Last Name:KO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E ROWAN AVE STE L4
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1281
Mailing Address - Country:US
Mailing Address - Phone:509-315-5751
Mailing Address - Fax:509-315-5751
Practice Address - Street 1:12 E ROWAN AVE STE L4
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207
Practice Address - Country:US
Practice Address - Phone:509-315-5751
Practice Address - Fax:509-315-5751
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11671171100000X
WAAC60015192171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty