Healthcare Provider Details

I. General information

NPI: 1154695914
Provider Name (Legal Business Name): YOONJU HUR L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2012
Last Update Date: 02/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 CRENSHAW BLVD STE 207
LOS ANGELES CA
90019-1950
US

IV. Provider business mailing address

321 S OCCIDENTAL BLVD APT 204
LOS ANGELES CA
90057-1574
US

V. Phone/Fax

Practice location:
  • Phone: 323-302-9126
  • Fax:
Mailing address:
  • Phone: 213-785-4990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: