Provider Demographics
NPI:1255476289
Name:WON, JONGHOUN (DOM,LAC)
Entity Type:Individual
Prefix:DR
First Name:JONGHOUN
Middle Name:
Last Name:WON
Suffix:
Gender:M
Credentials:DOM,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16625 CRENSHAW BLVD
Mailing Address - Street 2:23
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-2133
Mailing Address - Country:US
Mailing Address - Phone:626-787-1104
Mailing Address - Fax:
Practice Address - Street 1:350 S LAKE AVE STE 220
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3579
Practice Address - Country:US
Practice Address - Phone:626-787-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9630171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist