Provider Demographics
NPI:1093934614
Name:SUNG BO ACUPUNCTURE & HERBS
Entity Type:Organization
Organization Name:SUNG BO ACUPUNCTURE & HERBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LAC
Authorized Official - Phone:907-561-1828
Mailing Address - Street 1:4050 LAKE OTIS PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5220
Mailing Address - Country:US
Mailing Address - Phone:907-561-1828
Mailing Address - Fax:907-561-1834
Practice Address - Street 1:4050 LAKE OTIS PKWY STE 107
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5220
Practice Address - Country:US
Practice Address - Phone:907-561-1828
Practice Address - Fax:907-561-1834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK62171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty