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General NPI Number Information
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NPI Number | 1255728036
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Entity Type | Organization
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Legal Business Name | IKJAE ACUPUNCTURE & HERBS CLINIC INC.
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 03/06/2021
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Provider Practice Location Address
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Address Line | 3663 W 6TH ST STE 202
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City | LOS ANGELES
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State | CA
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Zip | 90020-3048
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Country | US
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Telephone | 323-733-5940
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Fax |
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Provider Business Mailing Address
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Address Line | 3663 W 6TH ST STE 202
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City | LOS ANGELES
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State | CA
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Zip | 90020-3048
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Country | US
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Telephone | 323-733-5940
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Fax | 213-381-1701
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Authorized Official
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Title or Position | OWNER
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Name | MYUNG HWA CHUNG
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Credential | PH.D.
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Telephone | 323-733-5940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 7784
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License Number State | CA
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