Provider Demographics
NPI:1174881890
Name:CHO, HAENG SIK (AC)
Entity type:Individual
Prefix:
First Name:HAENG
Middle Name:SIK
Last Name:CHO
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 VALLEY VIEW ST
Mailing Address - Street 2:C-122
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1892
Mailing Address - Country:US
Mailing Address - Phone:714-864-8091
Mailing Address - Fax:
Practice Address - Street 1:7777 VALLEY VIEW ST
Practice Address - Street 2:C-122
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1871
Practice Address - Country:US
Practice Address - Phone:714-864-8091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13233171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC13233OtherSTATE OF CALIFORNIA ACUPUNCTURE BOARD LICENSE