Provider Demographics
NPI:1811215593
Name:JEOUNG, CHUL AN
Entity Type:Individual
Prefix:
First Name:CHUL
Middle Name:AN
Last Name:JEOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7285 9TH ST APT 9
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2788
Mailing Address - Country:US
Mailing Address - Phone:213-675-3539
Mailing Address - Fax:
Practice Address - Street 1:7285 9TH ST APT 9
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2788
Practice Address - Country:US
Practice Address - Phone:213-675-3539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11386171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist