Provider Demographics
NPI:1649802521
Name:CHA, PETER YONGSUK (LAC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:YONGSUK
Last Name:CHA
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 1:18837 BROOKHURST ST STE 210
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7302
Mailing Address - Country:US
Mailing Address - Phone:714-965-5145
Mailing Address - Fax:
Practice Address - Street 1:18837 BROOKHURST ST STE 210
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7302
Practice Address - Country:US
Practice Address - Phone:714-965-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18776171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist