Provider Demographics
NPI:1992869630
Name:JOO, CHUL K (LAC)
Entity type:Individual
Prefix:
First Name:CHUL
Middle Name:K
Last Name:JOO
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 1:2815 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2802
Mailing Address - Country:US
Mailing Address - Phone:818-541-6733
Mailing Address - Fax:
Practice Address - Street 1:3043 FOOTHILL BLVD
Practice Address - Street 2:SUITE NUMBER 15
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214
Practice Address - Country:US
Practice Address - Phone:818-541-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8136171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist