Provider Demographics
NPI:1821147919
Name:SHON, PHILLIP MANKEUN (LAC)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:MANKEUN
Last Name:SHON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 S VAN NESS AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-3201
Mailing Address - Country:US
Mailing Address - Phone:323-350-8332
Mailing Address - Fax:213-385-7875
Practice Address - Street 1:638 S VAN NESS AVE FL 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-3201
Practice Address - Country:US
Practice Address - Phone:323-350-8332
Practice Address - Fax:213-385-7875
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9186171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist