Provider Demographics
NPI:1588192439
Name:HWANG, SOO CHUN (LAC)
Entity Type:Individual
Prefix:
First Name:SOO CHUN
Middle Name:
Last Name:HWANG
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 1:9474 KEARNY VILLA RD STE 111
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4596
Mailing Address - Country:US
Mailing Address - Phone:858-987-6267
Mailing Address - Fax:858-707-7869
Practice Address - Street 1:9474 KEARNY VILLA RD STE 111
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4596
Practice Address - Country:US
Practice Address - Phone:858-987-6267
Practice Address - Fax:858-707-7869
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2023-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17544171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist