Provider Demographics
NPI:1518182880
Name:UM, SUK SANG SAMUEL (ACUPUNCTURE)
Entity Type:Individual
Prefix:MR
First Name:SUK SANG
Middle Name:SAMUEL
Last Name:UM
Suffix:
Gender:M
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4154
Mailing Address - Country:US
Mailing Address - Phone:323-887-7575
Mailing Address - Fax:323-887-7503
Practice Address - Street 1:1435 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4154
Practice Address - Country:US
Practice Address - Phone:323-887-7575
Practice Address - Fax:323-887-7503
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10295208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0102950OtherACUPUNCTURIST