Provider Demographics
NPI:1316183122
Name:KU, BON SEONG (LAC)
Entity Type:Individual
Prefix:MR
First Name:BON SEONG
Middle Name:
Last Name:KU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14764 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-4250
Mailing Address - Country:US
Mailing Address - Phone:714-757-8685
Mailing Address - Fax:978-334-5369
Practice Address - Street 1:14764 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-4250
Practice Address - Country:US
Practice Address - Phone:714-757-8685
Practice Address - Fax:978-334-5369
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12776171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist