Provider Demographics
NPI:1245556919
Name:CHUN, CHANGWON
Entity Type:Individual
Prefix:
First Name:CHANGWON
Middle Name:
Last Name:CHUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9519 TELEGRAPH
Mailing Address - Street 2:SUITE A
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660
Mailing Address - Country:US
Mailing Address - Phone:213-590-0555
Mailing Address - Fax:
Practice Address - Street 1:9519 TELEGRAPH RD
Practice Address - Street 2:SUITE A
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-5550
Practice Address - Country:US
Practice Address - Phone:213-590-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL.AC. 13083171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist