Healthcare Provider Details

I. General information

NPI: 1669701371
Provider Name (Legal Business Name): YOONKI JEONG AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 E THOUSAND OAKS BLVD
THOUSAND OAKS CA
91362-3403
US

IV. Provider business mailing address

3188 E. THOUSANS OAKS BLVD
THOUSAND OAKS CA
91362-3403
US

V. Phone/Fax

Practice location:
  • Phone: 805-496-8000
  • Fax:
Mailing address:
  • Phone: 805-496-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number8076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: