Provider Demographics
NPI:1235483025
Name:SOUTH BAYLO UNIVERSITY
Entity Type:Organization
Organization Name:SOUTH BAYLO UNIVERSITY
Other - Org Name:SOUTH BAYLO UNIVERSITY LA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:DEUK
Authorized Official - Middle Name:S
Authorized Official - Last Name:JANG
Authorized Official - Suffix:
Authorized Official - Credentials:OMD, LAC
Authorized Official - Phone:213-738-1974
Mailing Address - Street 1:2727 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3111
Mailing Address - Country:US
Mailing Address - Phone:213-738-1974
Mailing Address - Fax:213-738-1923
Practice Address - Street 1:2727 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3111
Practice Address - Country:US
Practice Address - Phone:213-738-1974
Practice Address - Fax:213-738-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty