Provider Demographics
NPI:1518608587
Name:LA, AHRI JUNG
Entity Type:Individual
Prefix:
First Name:AHRI
Middle Name:JUNG
Last Name:LA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 ST SIMON CIR UNIT F
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-9116
Mailing Address - Country:US
Mailing Address - Phone:213-255-1912
Mailing Address - Fax:
Practice Address - Street 1:1499 HUNTINGTON DR STE 301
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5446
Practice Address - Country:US
Practice Address - Phone:626-817-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18139171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist