Provider Demographics
NPI:1780044313
Name:BOOJA SEONG ACUPUNCTURE
Entity Type:Organization
Organization Name:BOOJA SEONG ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAC
Authorized Official - Prefix:
Authorized Official - First Name:BOOJA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-375-7115
Mailing Address - Street 1:1773 GILDA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-6209
Mailing Address - Country:US
Mailing Address - Phone:408-375-7115
Mailing Address - Fax:
Practice Address - Street 1:100 OCONNOR DR STE 27
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1655
Practice Address - Country:US
Practice Address - Phone:408-375-7115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16833171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty