Provider Demographics
NPI:1720380124
Name:CHOI, KANG DAE (LAC)
Entity Type:Individual
Prefix:MR
First Name:KANG DAE
Middle Name:
Last Name:CHOI
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 1:1029 1/2 S BERENDO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2603
Mailing Address - Country:US
Mailing Address - Phone:213-388-1250
Mailing Address - Fax:213-388-1350
Practice Address - Street 1:1029 1/2 S BERENDO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2603
Practice Address - Country:US
Practice Address - Phone:213-388-1250
Practice Address - Fax:213-388-1350
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist