Provider Demographics
NPI:1568707057
Name:NAMGOONG, WON
Entity Type:Individual
Prefix:
First Name:WON
Middle Name:
Last Name:NAMGOONG
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 1:1724 W CATALPA AVE APT 314
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4055
Mailing Address - Country:US
Mailing Address - Phone:714-833-8521
Mailing Address - Fax:
Practice Address - Street 1:412 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3736
Practice Address - Country:US
Practice Address - Phone:562-697-7154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14530171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist