Provider Demographics
NPI:1437291374
Name:SO, BYUNG KWANG (DR)
Entity Type:Individual
Prefix:
First Name:BYUNG
Middle Name:KWANG
Last Name:SO
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
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Mailing Address - Street 1:5028 WILSHIRE BLVD
Mailing Address - Street 2:202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-6105
Mailing Address - Country:US
Mailing Address - Phone:323-692-0202
Mailing Address - Fax:
Practice Address - Street 1:5028 WILSHIRE BLVD
Practice Address - Street 2:202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-6105
Practice Address - Country:US
Practice Address - Phone:323-692-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7019171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist