MEDICARE: MR. SUNG UP HONG L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	U01810	MD

General Provider Information

NPI Number	:	1144399361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SUNG UP HONG L.AC

Provider Business Mailing Address
First Line	:	15731 S WESTERN AVE
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-6157
Country	:	US
Telephone Number	:	310-892-0723
Fax Number	:	310-808-0212

Provider Business Practice Location Address
First Line	:	5530 WISCONSIN AVE STE 1237
Second Line	:
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-4301
Country	:	US
Telephone Number	:	301-656-3746
Fax Number	:	301-656-3896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	02/13/2019

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