Provider Demographics
NPI:1407986268
Name:CHOO, KWANGMYUNG (LAC, OMD)
Entity Type:Individual
Prefix:MR
First Name:KWANGMYUNG
Middle Name:
Last Name:CHOO
Suffix:
Gender:M
Credentials:LAC, OMD
Other - Prefix:MR
Other - First Name:ALBERT
Other - Middle Name:KWANGMYUNG
Other - Last Name:CHOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, OMD
Mailing Address - Street 1:1906 OCEANSIDE BLVD
Mailing Address - Street 2:SUITE S
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4423
Mailing Address - Country:US
Mailing Address - Phone:760-754-2007
Mailing Address - Fax:888-355-6203
Practice Address - Street 1:1906 OCEANSIDE BLVD
Practice Address - Street 2:SUITE S
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4423
Practice Address - Country:US
Practice Address - Phone:760-754-2007
Practice Address - Fax:888-355-6203
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10231171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist