Provider Demographics
NPI:1093481343
Name:HONG, YOUNG TAEK
Entity Type:Individual
Prefix:
First Name:YOUNG TAEK
Middle Name:
Last Name:HONG
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:PO BOX 3698
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3698
Mailing Address - Country:US
Mailing Address - Phone:310-850-3398
Mailing Address - Fax:
Practice Address - Street 1:22339 HARBOR RIDGE LN UNIT 3
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2408
Practice Address - Country:US
Practice Address - Phone:310-850-3398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19102171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist