Provider Demographics
NPI:1508015538
Name:CHOI, IKJUNG
Entity Type:Individual
Prefix:MR
First Name:IKJUNG
Middle Name:
Last Name:CHOI
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 1:2411 W 8TH ST
Mailing Address - Street 2:#204
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3919
Mailing Address - Country:US
Mailing Address - Phone:213-384-3559
Mailing Address - Fax:
Practice Address - Street 1:2411 W. 8TH ST.
Practice Address - Street 2:#204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-5026
Practice Address - Country:US
Practice Address - Phone:213-384-3559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7174171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist