Provider Demographics
NPI:1588315741
Name:WONGU HEALTH CENTER
Entity type:Organization
Organization Name:WONGU HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANGHYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OMD, LAC
Authorized Official - Phone:702-852-1280
Mailing Address - Street 1:8630 S EASTERN AVE # NV
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2836
Mailing Address - Country:US
Mailing Address - Phone:702-852-1280
Mailing Address - Fax:702-551-0411
Practice Address - Street 1:8630 S EASTERN AVE # NV
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2836
Practice Address - Country:US
Practice Address - Phone:702-852-1280
Practice Address - Fax:702-551-0411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WONGU UNIVERSITY OF ORIENTAL MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-10
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty