Provider Demographics
NPI:1578611851
Name:WON, BONGJA BENA (LAC, RN, PHD)
Entity Type:Individual
Prefix:
First Name:BONGJA
Middle Name:BENA
Last Name:WON
Suffix:
Gender:F
Credentials:LAC, RN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11239 VENTURA BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3167
Mailing Address - Country:US
Mailing Address - Phone:818-508-6888
Mailing Address - Fax:818-508-6778
Practice Address - Street 1:11239 VENTURA BLVD STE 214
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3167
Practice Address - Country:US
Practice Address - Phone:818-508-6888
Practice Address - Fax:818-508-6778
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4975171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist