Provider Demographics
NPI:1114069630
Name:O'BRIEN, COURTNEY SUNG ILL JOO (LAC)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:SUNG ILL JOO
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 E KAREN DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4811
Mailing Address - Country:US
Mailing Address - Phone:602-330-2015
Mailing Address - Fax:
Practice Address - Street 1:7742 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6525
Practice Address - Country:US
Practice Address - Phone:480-730-4991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0511171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist