Provider Demographics
NPI:1932942828
Name:YANG, EUNHO (LAC)
Entity type:Individual
Prefix:MR
First Name:EUNHO
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3649 GLENDON AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-7701
Mailing Address - Country:US
Mailing Address - Phone:217-552-5677
Mailing Address - Fax:
Practice Address - Street 1:4433 S ALAMEDA ST # C-0
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90058-2008
Practice Address - Country:US
Practice Address - Phone:310-733-7523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19583171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist