Provider Demographics
NPI:1902381619
Name:YANG, DONGCHUL (LAC)
Entity Type:Individual
Prefix:MR
First Name:DONGCHUL
Middle Name:
Last Name:YANG
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 1:3523 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3502
Mailing Address - Country:US
Mailing Address - Phone:323-733-8887
Mailing Address - Fax:323-733-3339
Practice Address - Street 1:3523 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3502
Practice Address - Country:US
Practice Address - Phone:323-733-8887
Practice Address - Fax:323-733-3339
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17557171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist