Provider Demographics
NPI:1114751963
Name:BAN, JUYUN
Entity type:Individual
Prefix:
First Name:JUYUN
Middle Name:
Last Name:BAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 IROLO ST APT 218
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2385
Mailing Address - Country:US
Mailing Address - Phone:213-554-4536
Mailing Address - Fax:
Practice Address - Street 1:440 SHATTO PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1793
Practice Address - Country:US
Practice Address - Phone:213-554-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20128171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist