Healthcare Provider Details

I. General information

NPI: 1043138175
Provider Name (Legal Business Name): WONGU HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 S EASTERN AVE
LAS VEGAS NV
89123-2836
US

IV. Provider business mailing address

8630 S EASTERN AVE
LAS VEGAS NV
89123-2836
US

V. Phone/Fax

Practice location:
  • Phone: 702-852-1280
  • Fax: 702-946-5050
Mailing address:
  • Phone: 702-852-1280
  • Fax: 702-946-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JOHN PARK
Title or Position: PRESIDENT
Credential:
Phone: 702-463-2122