Provider Demographics
NPI:1265202261
Name:LYNWOOD FAMILY CHIROPRACTIC AND SPORTS MEDICINE
Entity type:Organization
Organization Name:LYNWOOD FAMILY CHIROPRACTIC AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONG HYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:GWAG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-334-6211
Mailing Address - Street 1:3140 SAN MARINO ST UNIT 403
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1475
Mailing Address - Country:US
Mailing Address - Phone:714-334-6211
Mailing Address - Fax:
Practice Address - Street 1:3150 E IMPERIAL HWY STE 200
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3226
Practice Address - Country:US
Practice Address - Phone:310-609-2827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty