Provider Demographics
NPI:1679700793
Name:AN, HORYUL (LAC)
Entity Type:Individual
Prefix:MR
First Name:HORYUL
Middle Name:
Last Name:AN
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 1:17127 PIONEER BLVD
Mailing Address - Street 2:# H
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-2757
Mailing Address - Country:US
Mailing Address - Phone:714-980-3626
Mailing Address - Fax:562-865-7763
Practice Address - Street 1:5828 44TH AVE APT 11B
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7789
Practice Address - Country:US
Practice Address - Phone:714-980-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12688171100000X
NY004969171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist