Provider Demographics
NPI:1053575894
Name:CHE, JEREMY BONGHYUN (LAC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:BONGHYUN
Last Name:CHE
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 1:12727 SHERMAN WAY
Mailing Address - Street 2:C05
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-5032
Mailing Address - Country:US
Mailing Address - Phone:818-982-8398
Mailing Address - Fax:
Practice Address - Street 1:12727 SHERMAN WAY
Practice Address - Street 2:C05
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-5032
Practice Address - Country:US
Practice Address - Phone:818-982-8398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11092171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist