Provider Demographics
NPI:1982783114
Name:ZEON, KYUHO
Entity Type:Individual
Prefix:DR
First Name:KYUHO
Middle Name:
Last Name:ZEON
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 1:3545 WILSHIRE BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2378
Mailing Address - Country:US
Mailing Address - Phone:213-389-3818
Mailing Address - Fax:213-389-3819
Practice Address - Street 1:3545 WILSHIRE BLVD STE 206
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2378
Practice Address - Country:US
Practice Address - Phone:213-389-3818
Practice Address - Fax:213-389-3819
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8524171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1037353Medicare UPIN