Healthcare Provider Details

I. General information

NPI: 1447428131
Provider Name (Legal Business Name): SCOTT SEOK-HWAN BAHNG L.AC., DIPL.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E ONTARIO AVE
CORONA CA
92881-3793
US

IV. Provider business mailing address

1279 S GOLDSTONE CIR
ANAHEIM CA
92804-4669
US

V. Phone/Fax

Practice location:
  • Phone: 951-279-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: