Healthcare Provider Details

I. General information

NPI: 1821745167
Provider Name (Legal Business Name): SARAH JEONG L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5831 BEACH BLVD
BUENA PARK CA
90621-2021
US

IV. Provider business mailing address

1919 W CORONET AVE SPC 192
ANAHEIM CA
92801-1747
US

V. Phone/Fax

Practice location:
  • Phone: 703-303-2033
  • Fax:
Mailing address:
  • Phone: 703-303-2033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: