Provider Demographics
NPI:1689700478
Name:PYO, CHUNG YOL (LAC)
Entity Type:Individual
Prefix:MR
First Name:CHUNG
Middle Name:YOL
Last Name:PYO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16785 BEAR VALLEY ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1423
Mailing Address - Country:US
Mailing Address - Phone:760-870-4181
Mailing Address - Fax:760-646-8037
Practice Address - Street 1:16785 BEAR VALLEY ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1423
Practice Address - Country:US
Practice Address - Phone:760-870-4181
Practice Address - Fax:760-646-8037
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7406171100000X
CA7406171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
20444Medicare UPIN