Provider Demographics
NPI:1013165323
Name:AN, KYE JONG (LAC)
Entity Type:Individual
Prefix:
First Name:KYE JONG
Middle Name:
Last Name:AN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:4517 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-2701
Mailing Address - Country:US
Mailing Address - Phone:323-469-9789
Mailing Address - Fax:323-469-0851
Practice Address - Street 1:4517 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-2701
Practice Address - Country:US
Practice Address - Phone:323-469-9789
Practice Address - Fax:323-469-0851
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC5675171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist