Healthcare Provider Details

I. General information

NPI: 1679719207
Provider Name (Legal Business Name): HYUNG BONG STEVE CHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2009
Last Update Date: 01/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E DEL MAR BLVD STE 208
PASADENA CA
91105-2552
US

IV. Provider business mailing address

200 E DEL MAR BLVD STE 208
PASADENA CA
91105-2552
US

V. Phone/Fax

Practice location:
  • Phone: 626-378-1614
  • Fax: 626-243-4825
Mailing address:
  • Phone: 626-378-1614
  • Fax: 626-243-4825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberL.AC.12373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: