Healthcare Provider Details

I. General information

NPI: 1992218291
Provider Name (Legal Business Name): SUNG SHIK KUK L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 S UNION AVE
LOS ANGELES CA
90007-1843
US

IV. Provider business mailing address

2310 S UNION AVE
LOS ANGELES CA
90007-1843
US

V. Phone/Fax

Practice location:
  • Phone: 213-537-9060
  • Fax:
Mailing address:
  • Phone: 213-537-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17944
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: