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General NPI Number Information
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NPI Number | 1093162158
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Entity Type | Individual
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Provider Name | JUNGSOO WIENER LAC
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Gender | Female
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 28501 CANWOOD ST UNIT 3C
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City | AGOURA HILLS
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State | CA
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Zip | 91301-3206
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Country | US
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Telephone | 310-894-8785
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Fax |
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Provider Business Mailing Address
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Address Line | 474 SAVONA WAY
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City | OAK PARK
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State | CA
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Zip | 91377-4841
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Country | US
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Telephone | 310-894-8785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 16976
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License Number State | CA
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