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General NPI Number Information
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NPI Number | 1124167382
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA UNIVERSITY-SOMA
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 06/15/2016
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Provider Practice Location Address
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Address Line | 3460 WILSHIRE BLVD STE 500
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City | LOS ANGELES
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State | CA
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Zip | 90010-2223
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Country | US
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Telephone | 213-413-9500
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Fax | 213-413-5400
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Provider Business Mailing Address
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Address Line | 3460 WILSHIRE BLVD STE 500
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City | LOS ANGELES
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State | CA
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Zip | 90010-2223
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Country | US
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Telephone | 213-413-9500
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Fax | 213-413-5400
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Authorized Official
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Title or Position | ACADEMIC DEAN
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Name | MRS. KATHERINE HYUNSOOK CHO
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Credential | LAC
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Telephone | 213-413-9500
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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 | AC4924
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License Number State | CA
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