=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114047644
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANGJIN CHUN L.AC.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 11/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7128 PACIFIC BLVD # H
-----------------------------------------------------
City | HUNTINGTON PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90255-4776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-448-3028
-----------------------------------------------------
Fax | 323-277-9230
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7128 PACIFIC BLVD # H
-----------------------------------------------------
City | HUNTINGTON PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90255-4776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-448-3028
-----------------------------------------------------
Fax | 323-277-9230
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC4955
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------