Provider Demographics
NPI:1821685009
Name:EOM, WOO JIN
Entity Type:Individual
Prefix:
First Name:WOO JIN
Middle Name:
Last Name:EOM
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 1:4600 BEACH BLVD STE O
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1168
Mailing Address - Country:US
Mailing Address - Phone:714-880-5454
Mailing Address - Fax:
Practice Address - Street 1:4600 BEACH BLVD STE O
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1168
Practice Address - Country:US
Practice Address - Phone:714-880-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18449171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist