Provider Demographics
NPI:1861568420
Name:SUM, ROSE P (LAC)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:P
Last Name:SUM
Suffix:
Gender:F
Credentials:LAC
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Mailing Address - Street 1:11340 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 356
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1608
Mailing Address - Country:US
Mailing Address - Phone:310-479-7536
Mailing Address - Fax:310-479-7616
Practice Address - Street 1:11340 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 356
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1608
Practice Address - Country:US
Practice Address - Phone:310-479-7536
Practice Address - Fax:310-479-7616
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAAC5938171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist