Provider Demographics
NPI:1386022812
Name:HA, EUN KYUNG
Entity Type:Individual
Prefix:
First Name:EUN KYUNG
Middle Name:
Last Name:HA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 WILSHIRE BLVD APT 1610
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3228
Mailing Address - Country:US
Mailing Address - Phone:323-819-9854
Mailing Address - Fax:
Practice Address - Street 1:3810 WILSHIRE BLVD APT 1610
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3228
Practice Address - Country:US
Practice Address - Phone:323-819-9854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 16438171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist