=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154690824
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GRACE JUNG L.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2011
-----------------------------------------------------
Last Update Date | 11/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3832 WILSHIRE BLVD STE 103
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90010-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-388-8820
-----------------------------------------------------
Fax | 213-529-4086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3832 WILSHIRE BLVD STE 103
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90010-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-210-1803
-----------------------------------------------------
Fax | 213-529-4086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC13686
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------