Provider Demographics
NPI:1134537012
Name:JUN, KYUNG TAI (BACHELOR OF MEDICINE)
Entity type:Individual
Prefix:MR
First Name:KYUNG TAI
Middle Name:
Last Name:JUN
Suffix:
Gender:M
Credentials:BACHELOR OF MEDICINE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14441 BEACH BLVD #106
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683
Mailing Address - Country:US
Mailing Address - Phone:714-899-4843
Mailing Address - Fax:805-832-6039
Practice Address - Street 1:14441 BEACH BLVD #106
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-899-4843
Practice Address - Fax:805-832-6039
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14517171100000X
CALAC14517171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist