Provider Demographics
NPI:1376862557
Name:WEON, SUK KYENG (LICAC)
Entity Type:Individual
Prefix:
First Name:SUK KYENG
Middle Name:
Last Name:WEON
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:WEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICAC
Mailing Address - Street 1:23331 EL TORO RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4891
Mailing Address - Country:US
Mailing Address - Phone:949-241-1172
Mailing Address - Fax:949-305-4493
Practice Address - Street 1:23331 EL TORO RD
Practice Address - Street 2:SUITE 206
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4891
Practice Address - Country:US
Practice Address - Phone:949-241-1172
Practice Address - Fax:949-305-4493
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALIC.AC9945171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist