Provider Demographics
NPI:1205959038
Name:KO, SOOCHUNG (LAC, DIPL OM)
Entity type:Individual
Prefix:
First Name:SOOCHUNG
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4400 KELLER AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-4281
Mailing Address - Country:US
Mailing Address - Phone:510-632-7801
Mailing Address - Fax:
Practice Address - Street 1:4400 KELLER AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-4281
Practice Address - Country:US
Practice Address - Phone:510-282-0174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11366171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist