Provider Demographics
NPI:1487229464
Name:NO, JOON JONG
Entity Type:Individual
Prefix:
First Name:JOON
Middle Name:JONG
Last Name:NO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 N AVENIDA ALIPAZ
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2201
Mailing Address - Country:US
Mailing Address - Phone:213-500-7864
Mailing Address - Fax:
Practice Address - Street 1:131 N AVENIDA ALIPAZ
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2201
Practice Address - Country:US
Practice Address - Phone:213-500-7864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16246171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty