MEDICARE: SOOJUNG JEONG 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	16348	CA

General Provider Information

NPI Number	:	1275939597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOOJUNG JEONG L.AC.

Provider Business Mailing Address
First Line	:	2045 S STATE COLLEGE BLVD
Second Line	:	445
City	:	ANAHEIM
State	:	CA
Zip	:	92806-0167
Country	:	US
Telephone Number	:	310-579-7774
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 S D ST
Second Line	:	STE108
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3253
Country	:	US
Telephone Number	:	909-783-9400
Fax Number	:

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

Provider Enumeration Date	:	11/13/2014
Last Update Date	:	11/13/2014

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Directions to “ SOOJUNG JEONG L.AC.” Practice Location

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