Provider Demographics
NPI:1699091660
Name:HAE DONG SUNG GOOK ACUPUNCTURE CLINIC
Entity type:Organization
Organization Name:HAE DONG SUNG GOOK ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALSOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-387-7903
Mailing Address - Street 1:300 S. HOBART BLVD.
Mailing Address - Street 2:400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3698
Mailing Address - Country:US
Mailing Address - Phone:213-387-7903
Mailing Address - Fax:323-979-1030
Practice Address - Street 1:300 S. HOBART BLVD.
Practice Address - Street 2:400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3698
Practice Address - Country:US
Practice Address - Phone:213-387-7903
Practice Address - Fax:323-979-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11355171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC11355OtherACUPUNCTURE