Provider Demographics
NPI:1730104159
Name:CHO, KYOUNG EUN (LAC)
Entity Type:Individual
Prefix:
First Name:KYOUNG
Middle Name:EUN
Last Name:CHO
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 1:1042 N FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:323-656-4151
Practice Address - Street 1:1042 N FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6103
Practice Address - Country:US
Practice Address - Phone:310-801-6250
Practice Address - Fax:323-656-4151
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4957171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist