Provider Demographics
NPI:1558843151
Name:FURUKAWA, JUNGRIM
Entity Type:Individual
Prefix:
First Name:JUNGRIM
Middle Name:
Last Name:FURUKAWA
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 1:31900 MISSION TRL STE 225
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4550
Mailing Address - Country:US
Mailing Address - Phone:951-674-5698
Mailing Address - Fax:951-389-3611
Practice Address - Street 1:31900 MISSION TRL STE 225
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4550
Practice Address - Country:US
Practice Address - Phone:951-674-5698
Practice Address - Fax:951-674-5698
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18125171100000X
CA18125171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist