Provider Demographics
NPI:1003933839
Name:GUDMUNDSEN, KIMI XIAO (LAC)
Entity Type:Individual
Prefix:MRS
First Name:KIMI
Middle Name:XIAO
Last Name:GUDMUNDSEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8037 E DESERT PINE DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-2414
Mailing Address - Country:US
Mailing Address - Phone:626-993-5108
Mailing Address - Fax:714-280-8488
Practice Address - Street 1:20265 VALLEY BLVD STE E
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2655
Practice Address - Country:US
Practice Address - Phone:626-993-5108
Practice Address - Fax:909-869-8401
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8229171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist