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General NPI Number Information
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NPI Number | 1184944852
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Entity Type | Individual
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Provider Name | CHOONG IL JANG L.AC
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Gender | Male
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Dates
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Enumeration Date | 06/04/2010
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Last Update Date | 06/04/2010
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Provider Practice Location Address
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Address Line | 4789 VINELAND AVE
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City | N HOLLYWOOD
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State | CA
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Zip | 91602-3518
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Country | US
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Telephone | 818-761-1661
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Fax | 818-761-0482
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Provider Business Mailing Address
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Address Line | 4789 VINELAND AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91602-3518
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Country | US
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Telephone | 818-761-1661
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Fax | 818-761-0482
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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 | 13556
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License Number State | CA
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