Provider Demographics
NPI:1720307556
Name:HWANG, BON
Entity Type:Individual
Prefix:
First Name:BON
Middle Name:
Last Name:HWANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 CRENSHAW BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1970
Mailing Address - Country:US
Mailing Address - Phone:323-306-0944
Mailing Address - Fax:323-306-0881
Practice Address - Street 1:1032 CRENSHAW BLVD STE G
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1970
Practice Address - Country:US
Practice Address - Phone:323-306-0944
Practice Address - Fax:323-306-0881
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4944171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist