Provider Demographics
NPI:1679775894
Name:CHO, JAE HYUN (LAC)
Entity type:Individual
Prefix:
First Name:JAE HYUN
Middle Name:
Last Name:CHO
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 1:270 E 7TH ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6602
Mailing Address - Country:US
Mailing Address - Phone:909-243-0867
Mailing Address - Fax:909-532-8666
Practice Address - Street 1:270 E 7TH ST STE 2A
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6602
Practice Address - Country:US
Practice Address - Phone:909-243-0867
Practice Address - Fax:909-532-8666
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2011-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11702171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist