Individual
MR. BONGKYU NAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
3975 JACKSON ST, SUITE 209, RIVERSIDE, CA 92503-3901
(951) 351-2377
(951) 351-2378
Mailing address
3975 JACKSON ST, SUITE 209, RIVERSIDE, CA 92503-3901
(951) 351-2377
(951) 351-2378
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC 15467
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC 15467
ACUPUNCTURE
CA
Enumeration date
06/10/2013
Last updated
06/10/2013
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