Provider Demographics
NPI:1437394863
Name:SUNG, TAE GU (LAC)
Entity Type:Individual
Prefix:
First Name:TAE GU
Middle Name:
Last Name:SUNG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13503 DALEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-6539
Mailing Address - Country:US
Mailing Address - Phone:714-932-8455
Mailing Address - Fax:
Practice Address - Street 1:3535 SAN DIMAS ST SUITE. 2
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:661-864-1150
Practice Address - Fax:661-864-1145
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist