=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952553570
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUN SUN CHOI LAC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2008
-----------------------------------------------------
Last Update Date | 07/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 E HOLT AVE # G27
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91767-5826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-248-2439
-----------------------------------------------------
Fax | 909-306-7776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 E HOLT AVE # G27
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91767-5826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-248-2439
-----------------------------------------------------
Fax | 909-306-7776
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 11380
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------