Provider Demographics
NPI:1568612976
Name:MO, ANDY MYUNGSOO (LAC, PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:MYUNGSOO
Last Name:MO
Suffix:
Gender:M
Credentials:LAC, PHD
Other - Prefix:DR
Other - First Name:MYUNGSOO
Other - Middle Name:
Other - Last Name:MO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, PHD
Mailing Address - Street 1:2616 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3104
Mailing Address - Country:US
Mailing Address - Phone:714-312-5460
Mailing Address - Fax:714-312-5460
Practice Address - Street 1:520 N BROOKHURST ST STE 102
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5207
Practice Address - Country:US
Practice Address - Phone:714-312-5460
Practice Address - Fax:714-312-5460
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01843171100000X
CA11989171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist