Provider Demographics
NPI:1376623751
Name:IN, JUN (LAC & PHD)
Entity Type:Individual
Prefix:DR
First Name:JUN
Middle Name:
Last Name:IN
Suffix:
Gender:M
Credentials:LAC & PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 S VERMONT AVE
Mailing Address - Street 2:STE 17
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2764
Mailing Address - Country:US
Mailing Address - Phone:213-480-6700
Mailing Address - Fax:213-480-6704
Practice Address - Street 1:1133 S VERMONT AVE
Practice Address - Street 2:STE 17
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2764
Practice Address - Country:US
Practice Address - Phone:213-480-6700
Practice Address - Fax:213-480-6704
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC0065380171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist