Provider Demographics
NPI:1093028698
Name:JANG, JUNGHO (LAC)
Entity Type:Individual
Prefix:
First Name:JUNGHO
Middle Name:
Last Name:JANG
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 1:1704 MIRAMONTE AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3766
Mailing Address - Country:US
Mailing Address - Phone:650-967-4323
Mailing Address - Fax:650-967-4540
Practice Address - Street 1:1704 MIRAMONTE AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3766
Practice Address - Country:US
Practice Address - Phone:650-967-4323
Practice Address - Fax:650-967-4540
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13366171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist