Provider Demographics
NPI:1922212661
Name:KWON, EUNYUN (AC)
Entity Type:Individual
Prefix:MS
First Name:EUNYUN
Middle Name:
Last Name:KWON
Suffix:
Gender:F
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 W VICTORIA AVE
Mailing Address - Street 2:# 25
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3178
Mailing Address - Country:US
Mailing Address - Phone:323-788-4478
Mailing Address - Fax:
Practice Address - Street 1:3407 W 6TH ST
Practice Address - Street 2:# 608
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2537
Practice Address - Country:US
Practice Address - Phone:323-788-4478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6351171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist