Provider Demographics
NPI:1003006826
Name:KIM, DONG S (LAC)
Entity Type:Individual
Prefix:PROF
First Name:DONG
Middle Name:S
Last Name:KIM
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 1:23300 CINEMA DR STE 240
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1776
Mailing Address - Country:US
Mailing Address - Phone:661-753-7911
Mailing Address - Fax:
Practice Address - Street 1:23300 CINEMA DR STE 240
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1776
Practice Address - Country:US
Practice Address - Phone:661-753-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL.AC10880171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist