Provider Demographics
NPI:1912059114
Name:KWON, CHOO EUI
Entity Type:Individual
Prefix:
First Name:CHOO
Middle Name:EUI
Last Name:KWON
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 1:8700 RESEDA BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5386
Mailing Address - Country:US
Mailing Address - Phone:818-709-2000
Mailing Address - Fax:818-709-0806
Practice Address - Street 1:8700 RESEDA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5386
Practice Address - Country:US
Practice Address - Phone:818-709-2000
Practice Address - Fax:818-709-0806
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC001034171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist