Provider Demographics
NPI:1801172853
Name:JUNG, DAE HO (LAC)
Entity type:Individual
Prefix:
First Name:DAE HO
Middle Name:
Last Name:JUNG
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 1:123 S FIGUEROA ST
Mailing Address - Street 2:APT 334
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2469
Mailing Address - Country:US
Mailing Address - Phone:714-887-4442
Mailing Address - Fax:
Practice Address - Street 1:123 S FIGUEROA ST
Practice Address - Street 2:APT 334
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2469
Practice Address - Country:US
Practice Address - Phone:714-887-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14538171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist