Provider Demographics
NPI:1396485413
Name:GWAG, DONG HYUN (DC)
Entity type:Individual
Prefix:DR
First Name:DONG HYUN
Middle Name:
Last Name:GWAG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:3140 SAN MARINO ST UNIT 403
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-1475
Practice Address - Country:US
Practice Address - Phone:714-334-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor