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General NPI Number Information
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NPI Number | 1295140929
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Entity Type | Organization
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Legal Business Name | ACUCENTER OF LA, INC
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Dates
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Enumeration Date | 06/20/2014
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 4465 WILSHIRE BLVD STE 303
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City | LOS ANGELES
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State | CA
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Zip | 90010-3716
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Country | US
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Telephone | 323-936-4000
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Fax | 323-936-4001
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Provider Business Mailing Address
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Address Line | 4465 WILSHIRE BLVD STE 303
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City | LOS ANGELES
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State | CA
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Zip | 90010-3716
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Country | US
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Telephone | 323-936-4000
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Fax | 323-936-4001
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Authorized Official
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Title or Position | CEO
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Name | DR. BONGKYUN SUH
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Credential | D.C., L.AC.
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Telephone | 323-936-2828
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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 | AC8688
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC9809
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC32983
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License Number State | CA
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