Provider Demographics
NPI:1851776926
Name:JEONG, BO YEON (LAC)
Entity Type:Individual
Prefix:MS
First Name:BO
Middle Name:YEON
Last Name:JEONG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 S SERRANO AVE
Mailing Address - Street 2:UNIT 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2698
Mailing Address - Country:US
Mailing Address - Phone:818-471-8310
Mailing Address - Fax:
Practice Address - Street 1:1036 S SERRANO AVE
Practice Address - Street 2:UNIT 301
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2698
Practice Address - Country:US
Practice Address - Phone:818-471-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14888171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist