Provider Demographics
NPI:1285968081
Name:KOO, HYUNJEONG (LAC)
Entity type:Individual
Prefix:
First Name:HYUNJEONG
Middle Name:
Last Name:KOO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 TISCH WAY STE 5PW
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2530
Mailing Address - Country:US
Mailing Address - Phone:408-260-8868
Mailing Address - Fax:408-260-8889
Practice Address - Street 1:3031 TISCH WAY STE 5PW
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2530
Practice Address - Country:US
Practice Address - Phone:408-260-8868
Practice Address - Fax:408-260-8889
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12995171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist