Provider Demographics
NPI:1396957858
Name:KANG, SUK HO (LAC)
Entity type:Individual
Prefix:
First Name:SUK
Middle Name:HO
Last Name:KANG
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 1:3727 W 6TH ST
Mailing Address - Street 2:STE 602
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-5105
Mailing Address - Country:US
Mailing Address - Phone:213-388-7822
Mailing Address - Fax:
Practice Address - Street 1:3727 W 6TH ST
Practice Address - Street 2:STE 602
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-5105
Practice Address - Country:US
Practice Address - Phone:213-388-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11128171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist