Provider Demographics
NPI:1205918455
Name:HAN, JEUNG S (LAC)
Entity type:Individual
Prefix:DR
First Name:JEUNG
Middle Name:S
Last Name:HAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3804
Mailing Address - Country:US
Mailing Address - Phone:323-936-8989
Mailing Address - Fax:213-381-5335
Practice Address - Street 1:327 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3804
Practice Address - Country:US
Practice Address - Phone:323-936-8989
Practice Address - Fax:213-381-5335
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4022171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist