Provider Demographics
NPI:1740494103
Name:KWON, JOUNG SOON (LAC)
Entity type:Individual
Prefix:MRS
First Name:JOUNG SOON
Middle Name:
Last Name:KWON
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 1:10262 LA HACIENDA AVE APT C10
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7640
Mailing Address - Country:US
Mailing Address - Phone:760-638-0031
Mailing Address - Fax:
Practice Address - Street 1:4482 BARRANCA PKWY
Practice Address - Street 2:SUITE248
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7701
Practice Address - Country:US
Practice Address - Phone:949-653-1612
Practice Address - Fax:949-653-1529
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11718171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist