Provider Demographics
NPI:1124216841
Name:CHUNG, KI MYEONG (L AC)
Entity Type:Individual
Prefix:MR
First Name:KI
Middle Name:MYEONG
Last Name:CHUNG
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 W OLYMPIC BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3734
Mailing Address - Country:US
Mailing Address - Phone:213-386-9940
Mailing Address - Fax:
Practice Address - Street 1:1830 W OLYMPIC BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-3734
Practice Address - Country:US
Practice Address - Phone:213-386-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3778171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist