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General NPI Number Information
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NPI Number | 1396996138
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Entity Type | Organization
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Legal Business Name | JA DEUK HANBANG CLINIC
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 3030 W OLYMPIC BLVD 210
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City | LOS ANGELES
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State | CA
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Zip | 90006-6501
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Country | US
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Telephone | 213-365-1758
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Fax | 213-365-1709
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Provider Business Mailing Address
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Address Line | 3030 W OLYMPIC BLVD 210
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City | LOS ANGELES
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State | CA
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Zip | 90006-6501
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Country | US
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Telephone | 213-365-1758
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Fax | 213-365-1709
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | YUNKYUNG KIM
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Credential |
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Telephone | 213-365-1758
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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 | AC11995
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License Number State | CA
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