Provider Demographics
NPI:1811109382
Name:KO, CHANG WOO (PHD, LAC)
Entity type:Individual
Prefix:DR
First Name:CHANG WOO
Middle Name:
Last Name:KO
Suffix:
Gender:M
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 LAUREL CANYON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3711
Mailing Address - Country:US
Mailing Address - Phone:818-980-7979
Mailing Address - Fax:818-980-7980
Practice Address - Street 1:3959 LAUREL CANYON BLVD STE A
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3711
Practice Address - Country:US
Practice Address - Phone:818-980-7979
Practice Address - Fax:818-980-7980
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6659171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist