Provider Demographics
NPI:1962840173
Name:PAK, JOO CHON (L AC)
Entity Type:Individual
Prefix:MR
First Name:JOO
Middle Name:CHON
Last Name:PAK
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 N VERDUGO RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1240
Mailing Address - Country:US
Mailing Address - Phone:818-248-1444
Mailing Address - Fax:818-248-1474
Practice Address - Street 1:3531 N VERDUGO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1240
Practice Address - Country:US
Practice Address - Phone:818-248-1444
Practice Address - Fax:818-248-1474
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2014-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15384171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist