Provider Demographics
NPI:1114047644
Name:CHUN, SANGJIN (LAC)
Entity Type:Individual
Prefix:MR
First Name:SANGJIN
Middle Name:
Last Name:CHUN
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 1:7128 PACIFIC BLVD # H
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4776
Mailing Address - Country:US
Mailing Address - Phone:213-448-3028
Mailing Address - Fax:323-277-9230
Practice Address - Street 1:7128 PACIFIC BLVD # H
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4776
Practice Address - Country:US
Practice Address - Phone:213-448-3028
Practice Address - Fax:323-277-9230
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4955171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3093829Medicaid