Provider Demographics
NPI:1922273986
Name:SUH, BONG J (L AC)
Entity Type:Individual
Prefix:MR
First Name:BONG
Middle Name:J
Last Name:SUH
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:838 N LA CIENEGA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4708
Mailing Address - Country:US
Mailing Address - Phone:310-659-6351
Mailing Address - Fax:310-659-6356
Practice Address - Street 1:838 N LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-4708
Practice Address - Country:US
Practice Address - Phone:310-659-6351
Practice Address - Fax:310-659-6356
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8218171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist