Provider Demographics
NPI:1326178856
Name:JOUNG, WON JO (LAC)
Entity Type:Individual
Prefix:MR
First Name:WON JO
Middle Name:
Last Name:JOUNG
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 1:1730 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-5645
Mailing Address - Country:US
Mailing Address - Phone:310-517-9028
Mailing Address - Fax:
Practice Address - Street 1:1730 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-5645
Practice Address - Country:US
Practice Address - Phone:310-517-9028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11289171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist