Provider Demographics
NPI:1972006195
Name:SOH, BAKYOUNG
Entity type:Individual
Prefix:MR
First Name:BAKYOUNG
Middle Name:
Last Name:SOH
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 1:5256 VISTA REAL
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3056
Mailing Address - Country:US
Mailing Address - Phone:213-503-6208
Mailing Address - Fax:
Practice Address - Street 1:5256 VISTA REAL
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-3056
Practice Address - Country:US
Practice Address - Phone:213-503-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16556171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC16556OtherCALIDORNIA ACUPUNCTURE BOARD
CAAC16556OtherCALUFORNIA ACUPUNCTURE BOARD