Provider Demographics
NPI:1366753105
Name:CHOI, JOHN JEONGWOOK (LAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JEONGWOOK
Last Name:CHOI
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 1:9764 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1615
Mailing Address - Country:US
Mailing Address - Phone:714-204-7906
Mailing Address - Fax:
Practice Address - Street 1:5730 BEACH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2090
Practice Address - Country:US
Practice Address - Phone:714-522-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-26
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12408171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist