Provider Demographics
NPI:1730790965
Name:JAHNG, HEESUN
Entity type:Individual
Prefix:
First Name:HEESUN
Middle Name:
Last Name:JAHNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 LUNA PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-4854
Mailing Address - Country:US
Mailing Address - Phone:510-826-6814
Mailing Address - Fax:
Practice Address - Street 1:1082 E EL CAMINO REAL STE 3
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3776
Practice Address - Country:US
Practice Address - Phone:510-826-6814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA077665171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist