Provider Demographics
NPI:1518091636
Name:CHA, HYON SOG (LAC)
Entity Type:Individual
Prefix:MR
First Name:HYON SOG
Middle Name:
Last Name:CHA
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 1:18261 SOLEDAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-3532
Mailing Address - Country:US
Mailing Address - Phone:661-251-4651
Mailing Address - Fax:
Practice Address - Street 1:18261 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91387-3532
Practice Address - Country:US
Practice Address - Phone:661-251-4651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10210171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist