Healthcare Provider Details

I. General information

NPI: 1124590369
Provider Name (Legal Business Name): JAEYOUNG HUH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S HOOVER ST APT 315
LOS ANGELES CA
90020-1218
US

IV. Provider business mailing address

401 S HOOVER ST APT 315
LOS ANGELES CA
90020-1218
US

V. Phone/Fax

Practice location:
  • Phone: 213-257-6772
  • Fax:
Mailing address:
  • Phone: 213-257-6772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC18323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: