Provider Demographics
NPI:1073925657
Name:CHO, WONJUNG
Entity Type:Individual
Prefix:
First Name:WONJUNG
Middle Name:
Last Name:CHO
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 1:521 BERRY WAY
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5902
Mailing Address - Country:US
Mailing Address - Phone:213-507-9304
Mailing Address - Fax:
Practice Address - Street 1:14191 NEWPORT AVE
Practice Address - Street 2:#B
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-5177
Practice Address - Country:US
Practice Address - Phone:213-507-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16022171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist