Provider Demographics
NPI:1922404532
Name:NA, WONJOON (LAC)
Entity Type:Individual
Prefix:
First Name:WONJOON
Middle Name:
Last Name:NA
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 1:1870 MOUNTAIN VIEW AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-1766
Mailing Address - Country:US
Mailing Address - Phone:909-799-3433
Mailing Address - Fax:
Practice Address - Street 1:1870 MOUNTAIN VIEW AVE STE 8
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-1766
Practice Address - Country:US
Practice Address - Phone:909-799-3433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-08
Last Update Date:2014-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16320171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist