Provider Demographics
NPI:1164996203
Name:KWON, SANG HYEUK (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:SANG HYEUK
Middle Name:
Last Name:KWON
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7980 ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3437
Mailing Address - Country:US
Mailing Address - Phone:201-879-4345
Mailing Address - Fax:714-736-0084
Practice Address - Street 1:4695 LARWIN AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-3510
Practice Address - Country:US
Practice Address - Phone:201-879-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18392171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist