Provider Demographics
NPI:1629963657
Name:KANG, SEUNGJOO (ACUPUNCTURE)
Entity type:Individual
Prefix:
First Name:SEUNGJOO
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S WESTERN AVE APT 815
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-4412
Mailing Address - Country:US
Mailing Address - Phone:571-533-0129
Mailing Address - Fax:
Practice Address - Street 1:800 S WESTERN AVE APT 815
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-4412
Practice Address - Country:US
Practice Address - Phone:571-533-0129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC20295171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist