Healthcare Provider Details

I. General information

NPI: 1295140929
Provider Name (Legal Business Name): ACUCENTER OF LA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4465 WILSHIRE BLVD STE 303
LOS ANGELES CA
90010-3716
US

IV. Provider business mailing address

4465 WILSHIRE BLVD STE 303
LOS ANGELES CA
90010-3716
US

V. Phone/Fax

Practice location:
  • Phone: 323-936-4000
  • Fax: 323-936-4001
Mailing address:
  • Phone: 323-936-4000
  • Fax: 323-936-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC32983
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8688
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9809
License Number StateCA

VIII. Authorized Official

Name: DR. BONGKYUN SUH
Title or Position: CEO
Credential: D.C., L.AC.
Phone: 323-936-2828