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General NPI Number Information
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NPI Number | 1790039709
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Entity Type | Individual
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Provider Name | GRAY DEUKSHIN JANG O.M.D , L.AC.
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Gender | Male
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 2727 WEST 6TH STREET
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City | LOS ANGELES
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State | CA
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Zip | 90057
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Country | US
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Telephone | 626-202-7787
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Fax |
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Provider Business Mailing Address
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Address Line | 2727 W 6TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90057-3111
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Country | US
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Telephone | 626-202-7787
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Fax |
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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 | 11847
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License Number State | CA
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