Provider Demographics
NPI:1558091645
Name:OHM, CHUNGSOOK (LAC)
Entity type:Individual
Prefix:
First Name:CHUNGSOOK
Middle Name:
Last Name:OHM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3465 W 8TH ST # 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2519
Mailing Address - Country:US
Mailing Address - Phone:213-326-4743
Mailing Address - Fax:
Practice Address - Street 1:3465 W 8TH ST # 208
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-2519
Practice Address - Country:US
Practice Address - Phone:213-326-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18793171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist