Provider Demographics
NPI:1396996138
Name:JA DEUK HANBANG CLINIC
Entity type:Organization
Organization Name:JA DEUK HANBANG CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:YUNKYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-365-1758
Mailing Address - Street 1:3030 W OLYMPIC BLVD
Mailing Address - Street 2:210
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-6501
Mailing Address - Country:US
Mailing Address - Phone:213-365-1758
Mailing Address - Fax:213-365-1709
Practice Address - Street 1:3030 W OLYMPIC BLVD
Practice Address - Street 2:210
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-6501
Practice Address - Country:US
Practice Address - Phone:213-365-1758
Practice Address - Fax:213-365-1709
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JA DEUK HANBANG CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-09
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11995171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty