Healthcare Provider Details

I. General information

NPI: 1447801626
Provider Name (Legal Business Name): DONG GWON HAN DC, DAOM, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6122 ORANGETHORPE AVE STE 107
BUENA PARK CA
90620-1343
US

IV. Provider business mailing address

6122 ORANGETHORPE AVE STE 107
BUENA PARK CA
90620-1343
US

V. Phone/Fax

Practice location:
  • Phone: 714-724-5786
  • Fax: 714-463-1568
Mailing address:
  • Phone: 714-724-5786
  • Fax: 714-463-1568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: