Provider Demographics
NPI:1558654269
Name:MA, SKY SUNG-JIN (LAC)
Entity Type:Individual
Prefix:
First Name:SKY
Middle Name:SUNG-JIN
Last Name:MA
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 1:440 SHATTO PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1793
Mailing Address - Country:US
Mailing Address - Phone:213-487-0150
Mailing Address - Fax:
Practice Address - Street 1:440 SHATTO PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1793
Practice Address - Country:US
Practice Address - Phone:213-487-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13314171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist