Provider Demographics
NPI:1811036171
Name:KO, MYUNG SOON (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MS
First Name:MYUNG
Middle Name:SOON
Last Name:KO
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1568 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-3332
Mailing Address - Country:US
Mailing Address - Phone:213-250-4111
Mailing Address - Fax:213-250-4111
Practice Address - Street 1:1568 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-3332
Practice Address - Country:US
Practice Address - Phone:213-250-4111
Practice Address - Fax:213-250-4111
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11302171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist