Provider Demographics
NPI:1790179117
Name:JUNG, JONGRAK (DC, LAC)
Entity Type:Individual
Prefix:
First Name:JONGRAK
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 W TEMPLE ST APT 524
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4441
Mailing Address - Country:US
Mailing Address - Phone:206-966-1600
Mailing Address - Fax:
Practice Address - Street 1:3544 W OLYMPIC BLVD # 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3500
Practice Address - Country:US
Practice Address - Phone:206-966-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60540813111N00000X
CA19268171100000X
CA34562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist