Provider Demographics
NPI:1982853404
Name:TAE, SUNG W (AC)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:W
Last Name:TAE
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20110 PIONEER BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7402
Mailing Address - Country:US
Mailing Address - Phone:562-860-8300
Mailing Address - Fax:562-860-8311
Practice Address - Street 1:20110 PIONEER BLVD STE E
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7402
Practice Address - Country:US
Practice Address - Phone:562-860-8300
Practice Address - Fax:562-860-8311
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5682171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC5682OtherLINCENSE