Provider Demographics
NPI:1902094659
Name:KONG, HYUNSUK (LAC)
Entity Type:Individual
Prefix:
First Name:HYUNSUK
Middle Name:
Last Name:KONG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11832 ROSECRANS AVE
Mailing Address - Street 2:#257
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4107
Mailing Address - Country:US
Mailing Address - Phone:562-863-7878
Mailing Address - Fax:
Practice Address - Street 1:11832 ROSECRANS AVE
Practice Address - Street 2:#257
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4107
Practice Address - Country:US
Practice Address - Phone:562-863-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11759171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist