Provider Demographics
NPI:1912937442
Name:SUH, BONGKYUN FRANCISCO (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:BONGKYUN
Middle Name:FRANCISCO
Last Name:SUH
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 WILSHIRE BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3716
Mailing Address - Country:US
Mailing Address - Phone:323-936-4000
Mailing Address - Fax:323-936-4001
Practice Address - Street 1:4465 WILSHIRE BLVD STE 303
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3716
Practice Address - Country:US
Practice Address - Phone:323-936-4000
Practice Address - Fax:323-936-4001
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8688171100000X
CADC32983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0086880Medicaid
CADC32983Medicaid