Provider Demographics
NPI:1861680423
Name:SUNGMO CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:SUNGMO CHIROPRACTIC CLINIC
Other - Org Name:SUNGMO MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:CHULWOO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-590-0001
Mailing Address - Street 1:9042 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE 299
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1370
Mailing Address - Country:US
Mailing Address - Phone:714-590-0001
Mailing Address - Fax:714-590-0007
Practice Address - Street 1:9042 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 299
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1370
Practice Address - Country:US
Practice Address - Phone:714-590-0001
Practice Address - Fax:714-590-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29566Medicare PIN