Provider Demographics
NPI:1023308947
Name:KOO, JAHYUN (LAC)
Entity type:Individual
Prefix:
First Name:JAHYUN
Middle Name:
Last Name:KOO
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 1:645 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3107
Mailing Address - Country:US
Mailing Address - Phone:213-703-2698
Mailing Address - Fax:424-287-2046
Practice Address - Street 1:645 W 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3107
Practice Address - Country:US
Practice Address - Phone:213-703-2698
Practice Address - Fax:424-287-2046
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14254171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty