Provider Demographics
NPI:1528572146
Name:YANG, TOM SUNGCHUL (LAC)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:SUNGCHUL
Last Name:YANG
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 1:20252 VIA GALILEO
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4071
Mailing Address - Country:US
Mailing Address - Phone:818-472-1649
Mailing Address - Fax:
Practice Address - Street 1:9036 RESEDA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5895
Practice Address - Country:US
Practice Address - Phone:818-472-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17948171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty