Individual
EUNJI BACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24331 EL TORO RD STE 200, LAGUNA WOODS, CA 92637-3116
(949) 586-3200
Mailing address
9412 CANTERBURY LN, GARDEN GROVE, CA 92841-3431
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA63479
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/21/2022
Last updated
01/23/2024
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