Healthcare Provider Details

I. General information

NPI: 1689440190
Provider Name (Legal Business Name): MYOBALANCE SUH AND JUNG CHIROPRACTIC, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3544 W OLYMPIC BLVD # 101
LOS ANGELES CA
90019-3500
US

IV. Provider business mailing address

3544 W OLYMPIC BLVD # 101
LOS ANGELES CA
90019-3500
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: PRESIDENT
Credential: DC, LAC
Phone: 213-913-5279