Provider Demographics
NPI:1073054102
Name:JANG, MISOON (LAC)
Entity Type:Individual
Prefix:
First Name:MISOON
Middle Name:
Last Name:JANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23412 MOULTON PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1744
Mailing Address - Country:US
Mailing Address - Phone:949-588-0158
Mailing Address - Fax:
Practice Address - Street 1:23412 MOULTON PKWY STE 210
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1744
Practice Address - Country:US
Practice Address - Phone:949-588-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17069171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist