Provider Demographics
NPI:1184944852
Name:JANG, CHOONG IL (LAC)
Entity type:Individual
Prefix:MR
First Name:CHOONG IL
Middle Name:
Last Name:JANG
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 1:4789 VINELAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-3518
Mailing Address - Country:US
Mailing Address - Phone:818-761-1661
Mailing Address - Fax:818-761-0482
Practice Address - Street 1:4789 VINELAND AVE
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-3518
Practice Address - Country:US
Practice Address - Phone:818-761-1661
Practice Address - Fax:818-761-0482
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13556171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13556OtherCALIFORNIA STATE LICENSE