Healthcare Provider Details

I. General information

NPI: 1013699834
Provider Name (Legal Business Name): SUH AND JUNG MYOBALANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 WILSHIRE BLVD STE 2311
LOS ANGELES CA
90010-1901
US

IV. Provider business mailing address

909 W TEMPLE ST APT 524A
LOS ANGELES CA
90012-4441
US

V. Phone/Fax

Practice location:
  • Phone: 213-913-5279
  • Fax:
Mailing address:
  • Phone: 213-913-5279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. JONGRAK JUNG
Title or Position: CEO
Credential: D.C, L.AC
Phone: 213-913-5279