Provider Demographics
NPI:1538325808
Name:JANG, YOUNG GIL (LAC)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:GIL
Last Name:JANG
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 1:1133 S. VERMONT AVE. SUITE # 22
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CALIFORNIA
Mailing Address - Zip Code:90006-2764
Mailing Address - Country:UM
Mailing Address - Phone:213-738-1033
Mailing Address - Fax:213-738-7186
Practice Address - Street 1:1133 S VERMONT AVE STE 22
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2764
Practice Address - Country:US
Practice Address - Phone:213-738-1033
Practice Address - Fax:213-738-7186
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4573171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC4573OtherCALIFORNIA STATE LICENSE