Healthcare Provider Details

I. General information

NPI: 1912937442
Provider Name (Legal Business Name): BONGKYUN FRANCISCO SUH D.C, L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/16/2015
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 TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC32983
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: