MEDICARE: JUJUBE WELLNESS INC

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

General Provider Information

NPI Number	:	1477416055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUJUBE WELLNESS INC

Provider Business Mailing Address
First Line	:	404 SHATTO PL APT 314
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1773
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 LA VENTA DR STE 105
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-3720
Country	:	US
Telephone Number	:	213-284-2629
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HONG TACK CHUNG
Credential	:
Telephone Number	:	213-284-2629

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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