Provider Demographics
NPI:1366642506
Name:HWANG, JUNG BAE (LAC)
Entity Type:Individual
Prefix:DR
First Name:JUNG
Middle Name:BAE
Last Name:HWANG
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 1:2525 W 8TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3830
Mailing Address - Country:US
Mailing Address - Phone:213-386-5358
Mailing Address - Fax:
Practice Address - Street 1:2525 W 8TH ST STE 206
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3830
Practice Address - Country:US
Practice Address - Phone:213-386-5358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7437171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist