Provider Demographics
NPI:1144399361
Name:HONG, SUNG UP (LAC)
Entity Type:Individual
Prefix:MR
First Name:SUNG
Middle Name:UP
Last Name:HONG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15731 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-6157
Mailing Address - Country:US
Mailing Address - Phone:310-892-0723
Mailing Address - Fax:310-808-0212
Practice Address - Street 1:5530 WISCONSIN AVE STE 1237
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4301
Practice Address - Country:US
Practice Address - Phone:301-656-3746
Practice Address - Fax:301-656-3896
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01810171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist