Provider Demographics
NPI:1639339492
Name:CHA, HYUNJU (LAC)
Entity Type:Individual
Prefix:DR
First Name:HYUNJU
Middle Name:
Last Name:CHA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 W OLYMPIC BLVD
Mailing Address - Street 2:STE 445
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2207
Mailing Address - Country:US
Mailing Address - Phone:213-368-0003
Mailing Address - Fax:
Practice Address - Street 1:2140 W OLYMPIC BLVD
Practice Address - Street 2:STE 445
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2207
Practice Address - Country:US
Practice Address - Phone:213-368-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11635171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA305120Medicaid
CA305124Medicare UPIN
CA305120Medicaid
CA305123Medicare PIN
CA305122Medicare Oscar/Certification