Provider Demographics
NPI:1548694136
Name:SUK, KWANG SOO (LAC)
Entity type:Individual
Prefix:
First Name:KWANG
Middle Name:SOO
Last Name:SUK
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 1:3030 W OLYMPIC BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-6505
Mailing Address - Country:US
Mailing Address - Phone:213-407-6900
Mailing Address - Fax:213-908-2417
Practice Address - Street 1:3030 W OLYMPIC BLVD STE 204
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-6505
Practice Address - Country:US
Practice Address - Phone:213-407-6900
Practice Address - Fax:213-908-2417
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAC11751171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist