Healthcare Provider Details

I. General information

NPI: 1316317902
Provider Name (Legal Business Name): PURUN SPINE AND ARTHRO CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W OLYMPIC BLVD SUITE 405
LOS ANGELES CA
90006-2207
US

IV. Provider business mailing address

2140 W. OLYMPIC BLVD., SUITE 405
LOS ANGELES CA
90006
US

V. Phone/Fax

Practice location:
  • Phone: 323-939-0807
  • Fax: 213-674-7908
Mailing address:
  • Phone: 323-939-0807
  • Fax: 213-674-7908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number24102
License Number StateCA

VIII. Authorized Official

Name: SOUNGDON CHUNG
Title or Position: CEO
Credential: D.C
Phone: 323-939-0807