Provider Demographics
NPI:1770013096
Name:BANG, EUNJU (LAC)
Entity Type:Individual
Prefix:
First Name:EUNJU
Middle Name:
Last Name:BANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6513 KOREMATSU CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-4571
Mailing Address - Country:US
Mailing Address - Phone:408-510-0704
Mailing Address - Fax:
Practice Address - Street 1:841 BLOSSOM HILL RD STE 107
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2704
Practice Address - Country:US
Practice Address - Phone:408-510-0704
Practice Address - Fax:408-323-8504
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17558171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist