MEDICARE: BUMSIK JEONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	18329	CA

General Provider Information

NPI Number	:	1174085716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BUMSIK JEONG

Provider Business Mailing Address
First Line	:	2307 SEPULVEDA WAY
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-4329
Country	:	US
Telephone Number	:	310-408-8813
Fax Number	:

Provider Business Practice Location Address
First Line	:	7261 WESTMINSTER BLVD
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-4235
Country	:	US
Telephone Number	:	714-379-2681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	04/03/2019

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Directions to “ BUMSIK JEONG ” Practice Location

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