Provider Demographics
NPI:1003175290
Name:KIM, SOO OUK (LAC)
Entity Type:Individual
Prefix:MR
First Name:SOO OUK
Middle Name:
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 1:700 19TH ST NW RM O-715
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20431-0001
Mailing Address - Country:US
Mailing Address - Phone:202-802-0296
Mailing Address - Fax:
Practice Address - Street 1:700 19TH ST NW RM O-715
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20431-0001
Practice Address - Country:US
Practice Address - Phone:202-802-0296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14487171100000X
DCAC500226171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist