Provider Demographics
NPI:1255728036
Name:IKJAE ACUPUNCTURE & HERBS CLINIC INC.
Entity type:Organization
Organization Name:IKJAE ACUPUNCTURE & HERBS CLINIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYUNG HWA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-733-5940
Mailing Address - Street 1:3663 W 6TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3048
Mailing Address - Country:US
Mailing Address - Phone:323-733-5940
Mailing Address - Fax:213-381-1701
Practice Address - Street 1:3663 W 6TH ST STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3048
Practice Address - Country:US
Practice Address - Phone:323-733-5940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7784261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care