Provider Demographics
NPI:1679719207
Name:CHA, HYUNG BONG STEVE
Entity Type:Individual
Prefix:
First Name:HYUNG BONG
Middle Name:STEVE
Last Name:CHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E DEL MAR BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2552
Mailing Address - Country:US
Mailing Address - Phone:626-378-1614
Mailing Address - Fax:626-243-4825
Practice Address - Street 1:200 E DEL MAR BLVD STE 208
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2552
Practice Address - Country:US
Practice Address - Phone:626-378-1614
Practice Address - Fax:626-243-4825
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-03
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL.AC.12373171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist