Provider Demographics
NPI:1700284601
Name:SUH, JUNGWON
Entity type:Individual
Prefix:MR
First Name:JUNGWON
Middle Name:
Last Name:SUH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 N BROOKHURST ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1789
Mailing Address - Country:US
Mailing Address - Phone:714-533-2580
Mailing Address - Fax:
Practice Address - Street 1:1132 N BROOKHURST ST
Practice Address - Street 2:UNIT A
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1789
Practice Address - Country:US
Practice Address - Phone:714-944-2944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist